TG/HDL-C Ratio as a Superior Diagnostic Biomarker for Coronary Plaque Burden in First-Time Acute Coronary

Background: Present ACS risk stratification predominantly depends on LDL-C, alt-hough its efficacy in diagnosing significant coronary plaque burden is constrained. We examined whether extensive lipid profiling, specifically the TG/HDL-C ratio, could function as a more effective diagnostic instrument for forecasting significant plaque burden in treatment-naïve first-time ACS patients. Methods: We examined 376 treat-ment-naïve patients undergoing PCI for first-time acute coronary syndrome. Using QCA, blinded angiographers were able to measure critical coronary lesions (≥70% ste-nosis in major vessels/≥50% left main). We measured the levels of lipids (LDL-C, HDL-C, TC, TG) and their ratios (LDL/HDL-C, TC/HDL-C, TG/HDL-C) when the per-son was admitted. Patients were classified according to the number of lesions (0, 1, 2, 3, ≥4). We used ANOVA, correlation, and multivariable linear regression to look at diag-nostic performance while controlling for confounders. Results: A significant graded increase in LDL-C (p=0.03), TC/HDL-C (p=0.02), and TG/HDL (p=0.01) was associated with an increasing lesion count. The strongest link was between TG/HDL-C, which went from 3.3 (0 lesions) to 5.3 (≥4 lesions). In multivariable analysis, TG/HDL-C (β=0.18, p=0.02) was a better independent predictor than LDL-C (β=0.14, p=0.04). A TG/HDL ratio greater than 4.0 identified patients with three or more lesions with 76% specificity. Conclusion: The TG/HDL-C ratio is a better diagnostic biomarker than LDL-C for finding a lot of coronary plaque in people who have had ACS for the first time. Adding it to routine admission profiling provides us with a cost-effective, imme-diately useful tool for early risk stratification, which can help us plan targeted inter-ventions and allocate resources in emergencies.