Neutrophil-to-high-density lipoprotein cholesterol ratio is related to in-stent neoatherosclerosis and plaque vulnerability: An optical coherence tomography study

Background: In-stent neoatherosclerosis (ISNA) is the primary cause of in-stent restenosis (ISR). The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) has been independently associated with atherosclerosis and coronary artery stenosis. Aims: To assess whether NHR predicts ISNA and vulnerable plaques in ISR patients using optical coherence tomography (OCT). Methods: This cross-sectional study enrolled 216 individuals with 220 ISR lesions who percutaneous coronary intervention guided by OCT between July 2018 and November 2022. Participants were stratified into tertiles based on NHR: tertile 1 (NHR <3.464; n = 72), tertile 2 (3.464 ≤NHR ≤5.131; n = 72), and tertile 3 (NHR >5.131; n = 72). The clinical baseline, angiographic, and OCT characteristics were recorded and analyzed. Associations between NHR, ISNA, and thin fibrous caps (TCFA) were analyzed using both univariable and multivariable logistic regression analyses. Receiver operating characteristic curve analysis was conducted to assess the diagnostic capability of NHR for identifying ISNA and TCFA. Results: The highest NHR tertile had higher incidences of ISNA and TCFA than the lowest tertile. NHR positively correlated with ISNA and plaque vulnerability. NHR was independently associated with ISNA and TCFA in multivariable models (ISNA: OR, 1.318; 95% CI, 1.145– 1.516; TCFA: OR, 1.369; 95% CI, 1.183–1.584). The areas under the curve were 0.656 for ISNA and 0.717 for TCFA. Receiver operating characteristic-derived cut-offs were NHR 4.058 for ISNA (sensitivity 69.72%; specificity 59.81%) and 4.109 for TCFA (sensitivity 83.93%; specificity 56.88%). Conclusions: In patients with DES-ISR, NHR was independently associated with OCT-defined ISNA and TCFA, with modest discrimination; moreover, larger prospective studies are needed to validate these findings