The Relation Between Monocyte to High-Density Lipoprotein Cholesterol Ratio and Short Term Outcome in Patients with Acute ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract
Background: Ischemic heart disease is considered the most common cause of death worldwide. Inflammation and oxidative stress play an important role in the pathogenesis of all phases of atherosclerosis and atherosclerotic plaque rupture which are the main mechanisms in the pathophysiology of acute ST-segment elevation myocardial infarction (STEMI). Monocyte to HDL ratio (MHR) was defined as a novel potential marker to determine inflammation and used to predict clinical outcome in patients with STEMI.
Objectives: To study the relation between monocyte to high-density lipoprotein cholesterol ratio and short-term outcome in patients with acute ST-segment elevation myocar-dial infarction undergoing primary percutaneous coronary intervention (PCI).
Methods: This study was conducted on a number of 100 patients diagnosed with STEMI and underwent primary PCI in Tanta University Hospitals, Cardiovascular Department, from June 2017 to December 2017. The primary end points were all cause mortality and major adverse cardiovascular events (MACE) including a composite of death, nonfatal re-infarction, target vessel re-vascularization, or new onset congestive heart failure during hospitalization and during the 3-months clinical follow-up.
Patients were divided into 3 tertiles according to the monocyte to high- density lipoprotein cholesterol ratio (MHR); Tertile 1: MHR20 (number of patients=23).
Results: Patients in the high MHR tertile showed signif-icantly lower systolic blood pressure, higher Killip class II-IV, lower final angiographic TIMI flow, higher WBCs, neu-trophils and monocytes count, higher serum LDL level and lower HDL levels, higher ejection fraction, higher all the composite endpoints of MACE including death, reinfarction and CHF. The study showed that MHR level >12.3 predicted the overall MACE following STEMI with a sensitivity and specificity above 75%. Conclusion: Monocyte to high-density lipoprotein cho-lesterol ratio is an independent prognostic factor for both in-hospital adverse outcomes, as well as, short-term adverse outcomes among STEMI patients who underwent primary PCI.