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Background <p>A coronary artery calcium (CAC) score of zero is generally considered a strong negative predictor for coronary heart disease (CHD). However, it does not exclude obstructive disease in symptomatic adults, particularly younger patients with non-calcified plaque. We evaluated whether Atherogenic Index of Plasma (AIP) and Neutrophil-to-HDL Ratio (NHR) improve identification of obstructive CHD in this population.</p> Methods <p>We analyzed 362 symptomatic adults with suspected premature CHD (men &lt; 55, women &lt; 65 years) and CAC = 0 from an invasive angiography registry. AIP and NHR were calculated from fasting laboratory tests. The endpoint was angiographic obstructive CHD (≥ 50% stenosis).</p> Results <p>Obstructive CHD occurred in 115/362 (31.8%). Adding AIP to traditional risk factors improved discrimination (area under the curve [AUC] 0.798 to 0.814) and model fit (Akaike information criterion [AIC] 337.8 to 333.1); adding NHR provided incremental improvement (AIC 331.6, AUC 0.818). Using internally derived cutoffs (AIP &gt; 0.13, NHR &gt; 3.08), the dual-high phenotype was associated with higher odds of obstructive CHD (odds ratio [OR] 4.59, 95% confidence interval [CI] 1.90–11.07, <i>P</i> &lt; 0.001) compared with the low AIP/low NHR group.</p> Conclusion <p>In symptomatic adults with suspected premature CHD and CAC = 0, the dual-high phenotype (elevated AIP and NHR) identifies a higher-risk subgroup for non-calcified obstructive disease. These findings underscore the limitations of CAC scoring alone in this population.</p>

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Combined value of AIP and NHR for identifying obstructive coronary heart disease in premature cases with zero calcium

  • 期刊论文

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  • 发表日期：

    2026年4月11日

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  • Min Wang,
  • Chao Xue,
  • Rong Zhu,
  • Alian Zhang,
  • Qizhi Chen

摘要

Background

A coronary artery calcium (CAC) score of zero is generally considered a strong negative predictor for coronary heart disease (CHD). However, it does not exclude obstructive disease in symptomatic adults, particularly younger patients with non-calcified plaque. We evaluated whether Atherogenic Index of Plasma (AIP) and Neutrophil-to-HDL Ratio (NHR) improve identification of obstructive CHD in this population.

Methods

We analyzed 362 symptomatic adults with suspected premature CHD (men < 55, women < 65 years) and CAC = 0 from an invasive angiography registry. AIP and NHR were calculated from fasting laboratory tests. The endpoint was angiographic obstructive CHD (≥ 50% stenosis).

Results

Obstructive CHD occurred in 115/362 (31.8%). Adding AIP to traditional risk factors improved discrimination (area under the curve [AUC] 0.798 to 0.814) and model fit (Akaike information criterion [AIC] 337.8 to 333.1); adding NHR provided incremental improvement (AIC 331.6, AUC 0.818). Using internally derived cutoffs (AIP > 0.13, NHR > 3.08), the dual-high phenotype was associated with higher odds of obstructive CHD (odds ratio [OR] 4.59, 95% confidence interval [CI] 1.90–11.07, P < 0.001) compared with the low AIP/low NHR group.

Conclusion

In symptomatic adults with suspected premature CHD and CAC = 0, the dual-high phenotype (elevated AIP and NHR) identifies a higher-risk subgroup for non-calcified obstructive disease. These findings underscore the limitations of CAC scoring alone in this population.