The Combined Effect of Platelet-to-HDL-Cholesterol Ratio and Glycemic Metabolism Status on the Prognosis of Patients Undergoing Percutaneous Coronary Intervention: A Large-Scale Retrospective Cohort Study

Background: The Platelet-to-HDL-cholesterol ratio (PHR), an emerging inflammatory biomarker, shows promise as a predictor in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD). However, the association between PHR and glycemic metabolism status and their combined effects on the prognosis of CAD patients undergoing percutaneous coronary intervention (PCI) remains unclear. Methods: A total of 31,761 CAD patients hospitalized for PCI were included. The primary endpoint was defined as major adverse cardiovascular events (MACEs). According to the median PHR levels, patients were grouped into higher levels of PHR (PHR-H) and lower levels of PHR (PHR-L) and further divided by glycemic status into four groups: PHR-H/T2DM, PHR-H/Non-T2DM, PHR-L/T2DM, PHR-L/Non-T2DM. Results: During the 1-year follow-up, 2258 (7.1%) MACEs occurred. Elevated PHR conferred 17% excess risk for MACEs. A 1-unit increase in LnPHR was associated with a 26% increased risk of MACEs in the T2DM cohort, and a 27% increase of MACEs risks in the non-T2DM cohort. Compared to those in PHR-H/T2DM group, patients in PHR-L/T2DM, PHR-H/Non-T2DM, PHR-L/Non-T2DM had significantly decreased risk of MACEs [adjusted hazard ratio (aHR): 0.83, 95% confidence interval (CI): 0.73-0.96, P =0.009; aHR: 0.81, 95% CI: 0.69-0.95, P =0.009; aHR: 0.70, 95% CI: 0.60-0.83, P