Epidemiology
Combining monocyte-to-HDL ratio with Lp(a) lifts in-stent restenosis prediction to an AUC of 0.860 in 190 stented patients (Front Cardiovasc Med 2025)
Original title: Predictive value of combined MHR and Lp(a) for in-stent restenosis in coronary heart disease patients: a study based on GEE model
In 190 coronary heart disease patients who underwent drug-eluting stent implantation between 2019 and 2024, 40 developed in-stent restenosis (ISR) on 1-year angiography versus 150 who did not. ISR patients had significantly higher monocyte count, monocyte-to-HDL ratio (MHR) and Lp(a) (all P < 0.05). Logistic regression and generalized estimating equation models identified monocyte count (odds ratio 1.949), Lp(a) (odds ratio 1.22) and MHR (odds ratio 1.009) as independent ISR predictors, with individual AUCs of 0.815, 0.672 and 0.726 respectively; combining MHR and Lp(a) raised the AUC to 0.860. A risk score built from these markers stratified patients effectively, with major adverse cardiovascular events occurring in 35% of the high-risk group versus 10% of the low-risk group. Adding Lp(a) to routine post-stent monitoring alongside inflammatory markers could improve early identification of patients heading toward restenosis.
Original abstract
Objective: To investigate the associations of monocyte count, lipoprotein(a) [Lp(a)], and monocyte-to-HDL ratio (MHR) with in-stent restenosis (ISR) in coronary heart disease (CHD) patients after drug-eluting stent (DES) implantation, and to develop a predictive risk model.
Methods: This study enrolled 190 CHD patients who underwent DES implantation from 2019 to 2024. Based on 1-year coronary angiography, patients were divided into an ISR group (n = 40) and a Non-ISR group (n = 150). Baseline characteristics, laboratory markers, coronary lesions, and stent parameters were analyzed. Logistic regression and generalized estimating equation (GEE) models were used to identify independent predictors. ROC curves assessed the diagnostic performance. A risk score was constructed and its association with major adverse cardiovascular events (MACE) evaluated.
Results: Compared to the Non-ISR group, ISR patients had higher monocyte count, MHR, and Lp(a) levels (all P < 0.05), and more frequent left main and multivessel disease. Monocyte count (OR = 1.949), Lp(a) (OR = 1.22), and MHR (OR = 1.009) were independent risk factors for ISR. ROC analysis showed AUCs of 0.815, 0.672, and 0.726 for monocytes, Lp(a), and MHR, respectively. Combined detection of MHR and Lp(a) improved the AUC to 0.860. The risk score effectively stratified patients, with a higher MACE incidence in the high-risk group (35% vs. 10%).
Conclusion: Monocyte count, Lp(a), and MHR are closely linked to ISR in CHD patients post-DES. Combined assessment enhances risk prediction, offering a basis for early identification and personalized management to reduce restenosis and improve outcomes.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.