{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T09:02:02Z","timestamp":1785488522486,"version":"3.56.0"},"reference-count":29,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Atherosclerotic cardiovascular disease remains the leading cause of ischemic heart disease, with dyslipidemia representing one of its principal modifiable risk factors. This study sought to evaluate the association between residual coronary artery disease burden and contemporary lipid indices in patients presenting with a first episode of acute coronary syndrome. Methods: A total of 317 patients were retrospectively evaluated between January 2022 and June 2023. Demographic features, comorbid conditions, laboratory measurements, conventional lipid parameters, contemporary lipid ratios, SYNTAX scores (SS), and residual SYNTAX scores (rSS) were recorded. Following primary percutaneous coronary intervention (PCI), patients were categorized by residual SYNTAX score (rSS) as rSS-negative (score = 0) or rSS-positive (score \u2265 1). Results: Of the 317 patients, 174 had an rSS &gt; 0, with a median rSS of 6 (IQR, 3\u201310). Patients with rSS &gt; 0 had lower HDL-C and higher LDL-C\/HDL-C and non-HDL-C\/HDL-C ratios than those with rSS = 0. In adjusted models, HDL-C was inversely associated with rSS positivity (OR per 1-mg\/dL increase, 0.965; 95% CI, 0.932\u20130.999), whereas the LDL-C\/HDL-C ratio (OR per 1-unit increase, 1.337; 95% CI, 1.021\u20131.752) and the non-HDL-C\/HDL-C ratio (OR per 1-unit increase, 1.257; 95% CI, 1.017\u20131.553) were positively associated. Baseline SYNTAX score was the dominant predictor, and none of the lipid-extended models significantly improved discrimination over the reference model. Conclusions: HDL-C, the LDL-C\/HDL-C ratio, and the non-HDL-C\/HDL-C ratio were independently associated with residual SYNTAX score positivity following primary PCI in patients presenting with a first ACS. These routinely available lipid indices may provide complementary information regarding the presence of residual coronary disease in this specific patient population.<\/jats:p>","DOI":"10.3390\/diagnostics16152412","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:20:18Z","timestamp":1785486018000},"page":"2412","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Analysis of Lipid Indices in Predicting Residual SYNTAX Score After Primary PCI in Patients with Acute Coronary Syndrome"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2150-0018","authenticated-orcid":false,"given":"\u0130smail","family":"\u00dcn\u011fan","sequence":"first","affiliation":[{"name":"Department of Cardiology, School of Medicine, Yalova University, 77200 Yalova, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4777-1166","authenticated-orcid":false,"given":"Ramazan","family":"Aso\u011flu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Medicine, Yalova University, 77200 Yalova, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/S0140-6736(21)02391-6","article-title":"Acute coronary syndromes","volume":"399","author":"Bergmark","year":"2022","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Jebari Benslaiman, S., Galicia Garc\u00eda, U., Larrea Sebal, A., Rekondo Olaetxea, J., Alloza Moral, I., Vandenbroeck, K., Benito Vicente, A., and Mart\u00edn Pl\u00e1garo, C.A. (2022). Pathophysiology of Atherosclerosis. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23063346"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1080\/14017431.2022.2095434","article-title":"Holistic review and meta-analysis of independent impact of the residual SYNTAX score on prognosis in patients with acute coronary syndrome","volume":"56","author":"Li","year":"2022","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Gaggini, M., Gorini, F., and Vassalle, C. (2022). Lipids in Atherosclerosis: Pathophysiology and the Role of Calculated Lipid Indices in Assessing Cardiovascular Risk in Patients with Hyperlipidemia. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24010075"},{"key":"ref_5","first-page":"757","article-title":"Lipoprotein ratios: Physiological significance and clinical usefulness in cardiovascular prevention","volume":"5","author":"Pallardo","year":"2009","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.arcmed.2019.08.009","article-title":"Atherogenic Index of Plasma: Novel Predictive Biomarker for Cardiovascular Illnesses","volume":"50","year":"2019","journal-title":"Arch. Med. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.pathol.2018.11.006","article-title":"Non-HDL-cholesterol and apolipoprotein B compared with LDL-cholesterol in atherosclerotic cardiovascular disease risk assessment","volume":"51","author":"Carr","year":"2019","journal-title":"Pathology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.atherosclerosis.2016.08.018","article-title":"2016 ESC\/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)","volume":"253","author":"Hoes","year":"2016","journal-title":"Atherosclerosis"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"931","DOI":"10.5603\/KP.a2015.0086","article-title":"Lipoprotein ratios are better than conventional lipid parameters in predicting coronary heart disease in Chinese Han people","volume":"73","author":"Zhu","year":"2015","journal-title":"Kardiol. Pol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wang, X., Wang, Z., Li, B., and Yang, P. (2020). Prognosis evaluation of universal acute coronary syndrome: The interplay between SYNTAX score and ApoB\/ApoA1. BMC Cardiovasc. Disord., 20.","DOI":"10.1186\/s12872-020-01562-6"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ahmed, T.A.N., Othman, A.A.A., Demitry, S.R., and Elmaghraby, K.M. (2024). Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease. BMC Cardiovasc. Disord., 24.","DOI":"10.1186\/s12872-023-03657-2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"44","DOI":"10.18087\/cardio.2024.12.n2686","article-title":"Association of Severity of Coronary Artery Disease with Traditional Risk Factors, Clinical Characteristics and Carotid Plaque Burden in Patients with Acute Coronary Syndrome","volume":"64","author":"Bershtein","year":"2024","journal-title":"Kardiologiia"},{"key":"ref_13","first-page":"257","article-title":"Patients with Acute Coronary Syndrome Under 45 Years of Age","volume":"4","author":"Akkaya","year":"2021","journal-title":"Anatol. J. Fam. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/nrcardio.2015.124","article-title":"Dysfunctional HDL and atherosclerotic cardiovascular disease","volume":"13","author":"Rosenson","year":"2016","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1016\/j.jacc.2013.04.101","article-title":"Low high-density lipoprotein cholesterol is not a risk factor for recurrent vascular events in patients with vascular disease on intensive lipid-lowering medication","volume":"62","author":"Liem","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/MCA.0000000000000881","article-title":"Relationship between non\u2013high-density lipoprotein cholesterol\/apolipoprotein A-I and monocyte\/high-density lipoprotein cholesterol ratio and coronary heart disease","volume":"31","author":"Li","year":"2020","journal-title":"Coron. Artery Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1016\/S0140-6736(19)32519-X","article-title":"Application of non-HDL cholesterol for population-based cardiovascular risk stratification: Results from the Multinational Cardiovascular Risk Consortium","volume":"394","author":"Brunner","year":"2019","journal-title":"The Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"34","DOI":"10.23950\/jcmk\/12523","article-title":"The association between non-HDL cholesterol and SYNTAX score in premature heart disease","volume":"19","author":"Oflar","year":"2022","journal-title":"J. Clin. Med. Kaz."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/j.amjcard.2013.05.049","article-title":"Predictive value of lipoprotein indices for residual risk of acute myocardial infarction and sudden death in men with low-density lipoprotein cholesterol levels","volume":"112","author":"Tanaka","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.ihj.2024.10.004","article-title":"Association of non-HDL cholesterol with plaque burden and composition of culprit lesion in acute coronary syndrome. An intravascular ultrasound-virtual histology study","volume":"76","author":"Reddy","year":"2024","journal-title":"Indian Heart J."},{"key":"ref_21","first-page":"359","article-title":"Atherogenic index of plasma, castelli risk index and atherogenic coefficient-new parameters in assessing cardiovascular risk","volume":"3","author":"Bhardwaj","year":"2013","journal-title":"Int. J. Pharm. Biol. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1161\/01.CIR.85.1.37","article-title":"Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment","volume":"85","author":"Manninen","year":"1992","journal-title":"Circulation"},{"key":"ref_23","first-page":"702","article-title":"The impact of LDL-C\/HDL-C ratio on severity of coronary artery disease and 2-year outcome in patients with premature coronary heart disease: Results of a prospective, multicenter, observational cohort study","volume":"51","author":"Xu","year":"2023","journal-title":"Zhonghua Xin Xue Guan Bing. Za Zhi"},{"key":"ref_24","first-page":"4221","article-title":"Effect of LDL-C\/HDL-C ratio on severity of coronary artery disease and 2-year long-term prognosis in elderly patients with coronary heart disease","volume":"104","author":"Xu","year":"2024","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1080\/03007995.2023.2246889","article-title":"Association of the low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and major adverse cardiac and cerebrovascular events in patients with coronary heart disease undergoing percutaneous coronary intervention: A cohort study","volume":"39","author":"Ren","year":"2023","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"108168","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.108168","article-title":"Cross-sectional analysis of non-HDL\/HDL cholesterol ratio as a marker for cardiovascular disease risk in middle-aged and older adults: Evidence from the CHARLS study","volume":"34","author":"Liu","year":"2025","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1177\/2047487313494292","article-title":"LDL-cholesterol versus non-HDL-to-HDL-cholesterol ratio and risk for coronary heart disease in type 2 diabetes","volume":"21","author":"Eliasson","year":"2014","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1140215","DOI":"10.3389\/fcvm.2023.1140215","article-title":"The atherogenic index of plasma (AIP) is a predictor for the severity of coronary artery disease","volume":"10","author":"Li","year":"2023","journal-title":"Front Cardiovasc. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1093\/eurheartj\/ehz962","article-title":"Low-density lipoproteins cause atherosclerotic cardiovascular disease: Pathophysiological, genetic, and therapeutic insights: A consensus statement from the European Atherosclerosis Society Consensus Panel","volume":"41","author":"Krauss","year":"2020","journal-title":"Eur. Heart J."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/15\/2412\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:39:13Z","timestamp":1785487153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/15\/2412"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":29,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["diagnostics16152412"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16152412","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]}}}