Cureus. 2026 May 8;18(5):e108476. doi: 10.7759/cureus.108476. eCollection 2026 May.
ABSTRACT
INTRODUCTION: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide, particularly in developing countries such as India. Although percutaneous coronary intervention (PCI) has improved the management of coronary heart disease (CHD), post-PCI outcomes continue to be influenced by inflammatory and hematological parameters. Novel indices, including the hemoglobin-to-red cell distribution width ratio (HRR) and the monocyte-to-high-density lipoprotein ratio (MHR), have emerged as potential markers of inflammation, oxidative stress, and cardiovascular outcomes. This study aimed to evaluate the short-term prognostic association of HRR and MHR in patients with CHD undergoing PCI. The primary objective was to assess their relationship with six-month post-PCI clinical outcomes, while secondary objectives included evaluation of mortality, mild symptoms, composite poor outcome, and exploratory receiver operating characteristic (ROC)-derived cutoff values.
METHODOLOGY: This prospective cohort study included 138 patients with CHD who underwent PCI at Era's Lucknow Medical College and Hospital. Hematological and lipid parameters were analyzed using automated techniques, and HRR and MHR were calculated. Patients were followed for six months to assess post-PCI outcomes, including mild symptoms and mortality. Statistical analyses were performed using the independent-samples t-test, analysis of variance, chi-square test, and ROC curve analysis. Because of the limited cohort size and low number of mortality events, ROC-based mortality analysis was considered exploratory, and no multivariable regression model was performed.
RESULTS: The mean age of the patients was 56.64 ± 10.05 years. Of the 138 patients, 103 (74.6%) were male and 35 (25.4%) were female patients. HRR abnormality (≤1.0) was observed in 82/138 patients (59.4%), while MHR abnormality (≥0.14) was observed in 21/138 patients (15.2%). After PCI, 117/138 patients (84.8%) remained asymptomatic, 17/138 (12.3%) developed mild symptoms, and 4/138 (2.9%) died during follow-up. HRR values were significantly higher in male than female patients, whereas MHR did not differ significantly by sex. Elevated MHR was significantly associated with adverse post-PCI outcomes (p < 0.001). ROC analysis showed exploratory discriminative ability for mortality, with AUCs of 0.838 for HRR and 0.863 for MHR. These AUC values were derived internally from a small number of mortality events and should therefore be interpreted with caution.
CONCLUSION: Both HRR and MHR demonstrated short-term unadjusted prognostic associations in post-PCI CHD patients, with MHR showing numerically higher exploratory discriminatory performance for adverse outcomes. Larger studies with longer follow-up are needed to validate these findings. External validation and adequately powered multivariable analyses are required before HRR and MHR can be considered independent predictors or clinically generalizable thresholds. Given the small cohort, low mortality-event count, short follow-up, and absence of multivariable adjustment, these findings should be interpreted as preliminary and hypothesis-generating rather than definitive evidence for clinical risk stratification.
PMID:42261521 | PMC:PMC13242638 | DOI:10.7759/cureus.108476