关键词: 糖化血红蛋白/高密度脂蛋白胆固醇比值, 冠状动脉粥样硬化性心脏病, 冠状动脉病变, 冠状动脉三支病变, Gensini评分, 冠状动脉造影

Abstract: Objective  To investigate the association between the ratio of glycosylated hemoglobin A1c to high density lipoprotein-cholesterol (HbA1c/HDL-C)  and the severity of coronary artery lesion, specifically focusing on triple-vessel involvement. Methods  In this retrospective study, 313 patients diagnosed with coronary heart disease (CHD) through coronary angiography at the Cardiovascular Center of Beijing Tongren Hospital, Capital Medical University between June 2023 and September 2024 were divided into three groups: single-vessel disease (n=110), double-vessel disease (n=95), and triple-vessel disease (n=108). Univariate and multivariate Logistic regression were used to evaluate the association between HbA1c/HDL-C and triple-vessel disease, with subsequent subgroup analysis performed. The receiver operating characteristic (ROC) curve analysis was applied to evaluate the diagnostic performance of HbA1c/HDL-C for triple-vessel coronary artery disease. Spearman correlation analysis was utilized to examine the relationship between HbA1c/HDL-C and Gensini score. Results  The triple-vessel disease group had significantly higher HbA1c/HDL-C level than the single-vessel and double-vessel groups (P<0.001). Multivariate Logistic regression demonstrated that HbA1c/HDL-C remained independently associated with triple-vessel coronary artery lesion, regardless of its categorization as a continuous or categorical variable, with no significant interaction observed across subgroups. The results of ROC curve analysis showed that the area under the ROC curve of HbA1c/HDL-C for identifying triple-vessel coronary artery disease was 0.685 (95%CI: 0.625－0.746), the specificity was 58.5%, the sensitivity was 70.4%, and the optimal cut-off value was 5.63. Further analysis demonstrated that incorporating HbA1c/HDL-C into conventional clinical models significantly enhanced discriminative performance (net reclassification improvement, NRI=0.258, P=0.029; integrated discrimination improvement, IDI=0.021, P=0.013). Spearman correlation analysis revealed a statistically significant positive correlation between HbA1c/HDL-C and Gensini score (r=0.257, P＜0.001). Conclusion  HbA1c/HDL-C is significantly associated with the risk of triple-vessel coronary artery disease,  serving as an independent factor of coronary lesion severity. It has relatively good discriminatory efficacy for triple-vessel coronary artery disease.

Key words: glycosylated hemoglobin A1c/high density lipoprotein-cholesterol ratio, coronary heart disease,  , coronary artery disease, triple-vessel coronary artery disease, Gensini score, coronary angiography