Novel inflammatory and metabolic biomarkers and their association with SYNTAX score in coronary heart disease

doi:10.3969/j.issn.1674-8115.2026.07.013

Abstract

Abstract:

Objective ·To investigate the correlations of the neutrophil percentage-to-albumin ratio (NPAR), monocyte-to-high-density lipoprotein ratio (MHR), fibrosis-4 index (FIB-4), and lipoprotein(a) [LP(a)] levels with the synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score in patients with coronary heart disease. Methods ·A total of 289 patients with coronary heart disease hospitalized in the Department of Cardiovascular Medicine at Friendship Hospital, Ili Kazakh Autonomous Prefecture, from January 2023 to January 2025 and diagnosed by coronary angiography were enrolled. According to the SYNTAX score, patients were divided into a low-risk group (n=122), an intermediate-risk group (n=86), and a high-risk group (n=81). Baseline characteristics and laboratory data were collected, including age, history of hypertension, body mass index (BMI), gender, history of diabetes, smoking history, drinking habits, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, LP(a), creatinine, and uric acid. Multivariate Logistic regression analysis was performed to evaluate the associations between the above factors and the SYNTAX score. Moreover, receiver operating characteristic (ROC) curve analysis was used to assess the predictive accuracy of NPAR, MHR, FIB-4, and LP(a) for the SYNTAX score. Results ·No statistically significant differences were observed among the three groups in gender, age, BMI, history of hypertension, smoking history, blood lipids, creatinine, uric acid, or other baseline data (all P>0.05). However, the prevalence of diabetes and the levels of high-density lipoprotein cholesterol, LP(a), and NPAR differed significantly among the three groups (all P<0.05). After pooling the intermediate-risk and high-risk groups into an intermediate-high-risk group (n=167), comparison with the low-risk group (n=122) revealed a significantly higher prevalence of diabetes and elevated LP(a) and NPAR levels (all P<0.05). Multivariate Logistic regression analysis revealed that diabetes (OR=1.768, 95%CI 1.024‒3.051, P=0.041), NPAR (OR=5.386, 95%CI 2.216‒13.089, P<0.001), and LP(a) (OR=1.002, 95%CI 1.000‒1.003, P=0.043) were independent factors associated with high-risk coronary artery lesions. ROC curve analysis showed that the area under the curve (AUC) of NPAR was 0.641 (95%CI 0.576‒0.705, P<0.001), and that of LP(a) was 0.572 (95%CI 0.505‒0.639, P=0.038). The combined AUC of NPAR and LP(a) was 0.665 (95%CI 0.602‒0.728, P<0.001), which demonstrated superior predictive efficacy compared with either marker alone, whereas MHR (AUC=0.530, P=0.390) and FIB-4 (AUC=0.525, P=0.478) showed no statistically significant predictive value. Conclusion ·Both NPAR and LP(a) levels were positively associated with the SYNTAX score, suggesting their potential utility as reference markers for assessing the severity of coronary artery disease.

Key words: coronary heart disease, SYNTAX score, neutrophil percentage-to-albumin ratio, monocyte-to-high-density lipoprotein ratio, fibrosis index-4, lipoprotein (a)

CLC Number:

R541.4

Ziyawudong·Bawudong , Shahemu·Anaerbai , Asiya·Aierken , Yeerkenbieke·Shadeke , LI Guangjuan, Jiang Meng. Novel inflammatory and metabolic biomarkers and their association with SYNTAX score in coronary heart disease[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(7): 946-953.

Figures/Tables 5

TrendMD

References 23

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Characteristic	Low-risk group (n=122)	Medium-risk group (n=86)	High-risk group (n=81)	F/χ²/H value	P value
Gender/n(%)				3.995	0.136
Male	80 (65.6)	65 (75.6)	50 (61.7)
Female	42 (34.4)	21 (24.4)	31 (38.3)
Age/year	61.73±8.97	60.84±10.63	63.93±9.32	2.305	0.102
BMI/(kg·m^-2)	27.08±4.54	27.26±5.40	27.41±3.96	0.123	0.885
Hypertension/n(%)				1.291	0.524
No	43 (35.2)	37 (43.0)	31 (38.3)
Yes	79 (64.8)	49 (57.0)	50 (61.7)
Diabetes mellitus/n(%)				13.263	0.001
No	93 (76.2)	63 (73.3)	43 (53.1)
Yes	29 (23.8)	23 (26.7)	38 (46.9)
Smoking/n(%)				3.288	0.193
No	77 (63.1)	44 (51.2)	50 (61.7)
Yes	45 (36.9)	42 (48.8)	31 (38.3)
Alcohol consumption/n(%)				10.002	0.007
No	103 (84.4)	69 (80.2)	78 (96.3)
Yes	19 (15.6)	17 (19.8)	3 (3.7)
TC/(mmol·L^-1)	4.46±1.12	4.49±1.39	4.50±1.32	0.038	0.963
TG/(mmol·L^-1)	2.07±1.02	2.10±1.40	2.06±1.45	0.025	0.975
HDL-C/(mmol·L^-1)	1.26±0.32	1.24±0.27	1.15±0.26	3.557	0.030
LDL-C/(mmol·L^-1)	2.68±0.82	2.66±0.88	2.77±0.95	0.376	0.687
LP(a)/(mg·dL^-1)	142.00 (85.00, 259.00)	195.00 (105.77, 329.00)	190.00 (120.00, 345.50)	6.380	0.041
Creatinine/(μmol·L^-1)	74.20±18.46	73.53±18.45	78.77±28.39	1.472	0.231
UA/(μmol·L^-1)	297.72±99.46	315.94±110.88	294.50±92.15	1.149	0.318
NPAR	1.58 (1.45, 1.73)	1.73 (1.55, 1.90)	1.72 (1.45, 1.97)	16.399	<0.001
MHR	0.41 (0.30, 0.54)	0.41 (0.29, 0.58)	0.44 (0.32, 0.61)	1.509	0.470
FIB-4	34.82 (22.83, 47.30)	35.73 (22.65, 59.41)	33.88 (23.85, 55.25)	0.357	0.748

Characteristic	Low-risk group (n=122)	Medium-risk group (n=86)	High-risk group (n=81)	F/χ²/H value	P value
Gender/n(%)				3.995	0.136
Male	80 (65.6)	65 (75.6)	50 (61.7)
Female	42 (34.4)	21 (24.4)	31 (38.3)
Age/year	61.73±8.97	60.84±10.63	63.93±9.32	2.305	0.102
BMI/(kg·m^-2)	27.08±4.54	27.26±5.40	27.41±3.96	0.123	0.885
Hypertension/n(%)				1.291	0.524
No	43 (35.2)	37 (43.0)	31 (38.3)
Yes	79 (64.8)	49 (57.0)	50 (61.7)
Diabetes mellitus/n(%)				13.263	0.001
No	93 (76.2)	63 (73.3)	43 (53.1)
Yes	29 (23.8)	23 (26.7)	38 (46.9)
Smoking/n(%)				3.288	0.193
No	77 (63.1)	44 (51.2)	50 (61.7)
Yes	45 (36.9)	42 (48.8)	31 (38.3)
Alcohol consumption/n(%)				10.002	0.007
No	103 (84.4)	69 (80.2)	78 (96.3)
Yes	19 (15.6)	17 (19.8)	3 (3.7)
TC/(mmol·L^-1)	4.46±1.12	4.49±1.39	4.50±1.32	0.038	0.963
TG/(mmol·L^-1)	2.07±1.02	2.10±1.40	2.06±1.45	0.025	0.975
HDL-C/(mmol·L^-1)	1.26±0.32	1.24±0.27	1.15±0.26	3.557	0.030
LDL-C/(mmol·L^-1)	2.68±0.82	2.66±0.88	2.77±0.95	0.376	0.687
LP(a)/(mg·dL^-1)	142.00 (85.00, 259.00)	195.00 (105.77, 329.00)	190.00 (120.00, 345.50)	6.380	0.041
Creatinine/(μmol·L^-1)	74.20±18.46	73.53±18.45	78.77±28.39	1.472	0.231
UA/(μmol·L^-1)	297.72±99.46	315.94±110.88	294.50±92.15	1.149	0.318
NPAR	1.58 (1.45, 1.73)	1.73 (1.55, 1.90)	1.72 (1.45, 1.97)	16.399	<0.001
MHR	0.41 (0.30, 0.54)	0.41 (0.29, 0.58)	0.44 (0.32, 0.61)	1.509	0.470
FIB-4	34.82 (22.83, 47.30)	35.73 (22.65, 59.41)	33.88 (23.85, 55.25)	0.357	0.748

Characteristic	Low-risk group (n=122)	Intermediate-high-risk group (n=167)	t/χ²/Z value	P value
Gender/n(%)			0.347	0.556
Male	80 (65.6)	115 (68.9)
Female	42 (34.4)	52 (31.1)
Age/year	61.73±8.97	62.34±10.11	-0.527	0.598
BMI/(kg·m^-2)	27.08±4.54	27.33±4.75	-0.449	0.654
Hypertension/n(%)			0.893	0.345
No	43 (35.2)	68 (40.7)
Yes	79 (64.8)	99 (59.3)
Diabetes mellitus/n(%)			5.350	0.021
No	93 (76.2)	106 (63.5)
Yes	29 (23.8)	61 (36.5)
Smoking/n(%)			1.360	0.244
No	77 (63.1)	94 (56.3)
Yes	45 (36.9)	73 (43.7)
Alcohol consumption/n(%)			0.782	0.377
No	103 (84.4)	147 (88.0)
Yes	19 (15.6)	20 (12.0)
TC/(mmol·L^-1)	4.46±1.12	4.50±1.35	-0.272	0.786
TG/(mmol·L^-1)	2.07±1.02	2.08±1.42	-0.081	0.935
HDL-C/(mmol·L^-1)	1.26±0.32	1.20±0.27	2.974	0.086
LDL-C/(mmol·L^-1)	2.68±0.82	2.71±0.91	-0.313	0.754
LP(a)/(mg·dL^-1)	142.00 (85.00, 259.00)	191.00 (108.00, 343.00)	-2.491	0.013
Creatinine/(μmol·L^-1)	74.20±18.46	76.07±23.87	-0.719	0.473
UA/(μmol·L^-1)	297.72±99.46	305.54±102.48	-0.648	0.518
NPAR	1.58 (1.45, 1.73)	1.72 (1.52, 1.95)	-3.852	<0.001
MHR	0.41 (0.30, 0.54)	1.72 (1.52, 1.95)	-0.902	0.367
FIB-4	34.82 (22.83, 47.30)	34.66 (23.85, 56.65)	-0.721	0.471

Characteristic	Low-risk group (n=122)	Intermediate-high-risk group (n=167)	t/χ²/Z value	P value
Gender/n(%)			0.347	0.556
Male	80 (65.6)	115 (68.9)
Female	42 (34.4)	52 (31.1)
Age/year	61.73±8.97	62.34±10.11	-0.527	0.598
BMI/(kg·m^-2)	27.08±4.54	27.33±4.75	-0.449	0.654
Hypertension/n(%)			0.893	0.345
No	43 (35.2)	68 (40.7)
Yes	79 (64.8)	99 (59.3)
Diabetes mellitus/n(%)			5.350	0.021
No	93 (76.2)	106 (63.5)
Yes	29 (23.8)	61 (36.5)
Smoking/n(%)			1.360	0.244
No	77 (63.1)	94 (56.3)
Yes	45 (36.9)	73 (43.7)
Alcohol consumption/n(%)			0.782	0.377
No	103 (84.4)	147 (88.0)
Yes	19 (15.6)	20 (12.0)
TC/(mmol·L^-1)	4.46±1.12	4.50±1.35	-0.272	0.786
TG/(mmol·L^-1)	2.07±1.02	2.08±1.42	-0.081	0.935
HDL-C/(mmol·L^-1)	1.26±0.32	1.20±0.27	2.974	0.086
LDL-C/(mmol·L^-1)	2.68±0.82	2.71±0.91	-0.313	0.754
LP(a)/(mg·dL^-1)	142.00 (85.00, 259.00)	191.00 (108.00, 343.00)	-2.491	0.013
Creatinine/(μmol·L^-1)	74.20±18.46	76.07±23.87	-0.719	0.473
UA/(μmol·L^-1)	297.72±99.46	305.54±102.48	-0.648	0.518
NPAR	1.58 (1.45, 1.73)	1.72 (1.52, 1.95)	-3.852	<0.001
MHR	0.41 (0.30, 0.54)	1.72 (1.52, 1.95)	-0.902	0.367
FIB-4	34.82 (22.83, 47.30)	34.66 (23.85, 56.65)	-0.721	0.471

Variable	B	SE	Wald	df	P value	OR(95%CI)
Diabetes mellitus (yes)	0.570	0.278	4.185	1	0.041	1.768 (1.024‒3.051)
NPAR	1.684	0.453	13.810	1	<0.001	5.386 (2.216‒13.089)
LP(a)	0.002	0.001	4.084	1	0.043	1.002 (1.000‒1.003)
Constant	-3.019	0.792	14.512	1	<0.001	0.049