Hemoglobin-to-Creatinine Ratio Predicts One-Year Adverse Clinical Outcomes in ST-Elevation Myocardial Infarction: Retrospective and Propensity Score Matched Analysis
Year: 2025
Type: article
Abstract: Background/Objectives: Anemia and renal impairment are key predictors of adverse outcomes in acute coronary syndromes (ACSs). The hemoglobin-to-creatinine (Hb/Cr) ratio combines these parameters into a simple index. This study aimed to evaluate its prognostic value at discharge in patients with ST-elevation myocardial infarction (STEMI). Methods: The primary endpoint was one-year all-cause mortality; secondary endpoints included major bleeding and the composite of all-cause mortality or reinfarction. Optimal Hb/Cr cut-off values were identified using Liu’s method. Multivariable logistic regression and propensity score matching were used to assess associations with outcomes. Results: We analyzed 11,236 STEMI patients from the PRAISE registry with available hemoglobin and creatinine values at discharge. The optimal cut-points were 13.68 for mortality and 14.42 for secondary endpoints. Patients were stratified into low (<13.68; 26.5%) and high (≥13.68; 73.5%) Hb/Cr groups. The low Hb/Cr group was older, had more comorbidities, and received less intensive therapy. At one year, low Hb/Cr patients had significantly higher rates of all-cause mortality (8.7% vs. 2.4%), major bleeding (5.0% vs. 2.4%), and the composite outcome (11.5% vs. 4.9%). In the multivariate logistic regression, the Hb/Cr ratio was inversely associated with all outcomes, namely all-cause mortality (odds ratio [OR] 0.94; 95% confidence interval [CI]: 0.92–0.96), major bleeding (OR 0.96; 95% CI: 0.94–0.97), and the composite endpoint (OR 0.93; 95% CI: 0.91–0.96). The Hb/Cr ratio outperformed hemoglobin and creatinine alone in predicting mortality (AUC 0.684 vs. 0.649 and 0.645; p < 0.001). Conclusions: The Hb/Cr ratio is independently associated with one-year adverse outcomes in STEMI and may serve as a simple marker of increased vulnerability. Prospective studies are needed to validate its clinical utility.
Source: Journal of Clinical Medicine
DOI: 10.3390/jcm14082756
Authors: Luigi Spadafora, Stefano Cacciatore, Mattia Galli, Carlos Collet, Matteo Betti, Gianmarco Sarto, Beatrice Simeone, Erica Rocco, Fabrizio D’Ascenzo, Gaetano Maria De Ferrari, Ovidio De Filippo, Pierre Sabouret, Iginio Colaiori, Roberto Carnevale, Valentina Valenti, Carlo Gaudio, Francesca Romana Zimatore, Giacomo Frati, Francesco Versaci, Sebastiano Sciarretta, Giuseppe Biondi Zoccai, Marco Bernardi
Institutions: Sapienza University of Rome, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Maria Cecilia Hospital, Onze Lieve Vrouwziekenhuis Hospital, University of Milan, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, Sorbonne Université, Ospedale Santa Maria Goretti, Istituto Neurologico Mediterraneo, Azienda Ospedaliera Universitaria Integrata Verona
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,137
OpenAlex ID: W4409522208