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Platelet-to-Hemoglobin Ratio in Predicting Major Adverse Cardiovascular Events After Coronary Artery Bypass Grafting

Year: 2025

Type: article

Abstract: Purpose: Coronary artery bypass grafting (CABG) is widely recognized as the gold standard treatment for patients with complex coronary artery disease (CAD). The identification of reliable hematologic predictors for major adverse cardiovascular events (MACE) after CABG remains limited. In recent years, the platelet-to-hemoglobin ratio (PHR) has emerged as a promising prognostic marker in various cardiovascular conditions and malignancies. This study investigated the prognostic value of the PHR for predicting in-hospital and short-term adverse outcomes after CABG. Patients and Methods: This retrospective cohort study included 1672 Chinese patients who underwent isolated CABG surgery between 2015 and 2021. PHR was calculated as platelet count (× 10 9 /L) divided by hemoglobin (g/L). The primary endpoint was 3-point MACE (3P-MACE), including cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke during hospitalization. A predictive nomogram was developed and validated using bootstrap resampling. Results: In our study, individuals with elevated PHR levels were more likely to experience 3P-MACE and stroke. After propensity matching, the incidence of 3P-MACE was 5.7% in the high PHR group (PHR≥ 1.890) and 1.5% in the low PHR group ( P = 0.010). Multivariate analysis identified preoperative PHR (odds ratio: 1.800 [95% CI 1.073– 3.021], P =0.026) as an independent predictor for 3P-MACE post-CABG. A predictive nomogram for 3P-MACE following CABG was successfully developed. The predictive performance of PHR was comparable to NLR and PLR, with an area under the ROC curve (AUC) of 0.595 (95% CI 0.486– 0.691). Combining PHR with nomogram parameters improved AUC to 0.762 (95% CI 0.687– 0.837). Conclusion: Elevated PHR (≥ 1.890) was independently associated with postoperative 3P-MACE, reflecting the integrated effects of thrombosis and anemia risk. Although PHR demonstrated modest discrimination as a single variable, its integration into a multivariable nomogram improved predictive accuracy. These findings are hypothesis-generating and future multicenter, prospective validation studies are warranted. Keywords: platelet-to-hemoglobin ratio, predicting, major adverse cardiovascular events, coronary artery bypass, nomograms

Source: Vascular Health and Risk Management

DOI: 10.2147/vhrm.s562298