The clinical significance of the TG/HDL ratio in acute coronary syndrome subtype presentation

Abstract

INTRODUCTION: Acute Coronary Syndrome (ACS) rates vary globally, and new lipid biomarkers like the TG/HDL and LDL/HDL ratios are gaining attention for potential risk stratification. However, their relationship with ACS subtype presentation has not been thoroughly investigated. This study aimed to determine the relationship between Acute Coronary Syndrome (ACS) subtypes (STEMI vs. NSTEMI) and the TG/HDL and LDL/HDL ratios.

METHODS: A retrospective cross-sectional study using hospital medical records was conducted on 136 ACS patients from August 2024 to September 2025 at Buleleng General Hospital. Comprehensive data were extracted, and the primary outcome measure was the ACS subtype. The main independent variables were the TG/HDL ratio and the LDL/HDL ratio. Statistical analyses included ROC curve analysis, chi-squared tests, and logistic regression.

RESULTS: The majority of patients were under 65 years old (58.8%). ROC curve analysis determined cut-off values of 2.40 for TG/HDL ratio and 2.38 for LDL/HDL ratio. Univariate analysis revealed a statistically significant relationship between the TG/HDL ratio (OR = 0.462; p = 0.047) and ACS subtype presentation, whereas no significant relationship was observed for the LDL/HDL ratio (OR = 1.122; p = 0.766). However, multivariate analysis showed a borderline significant relationship between a high TG/HDL ratio and NSTEMI presentation (AOR=2.163; p=0.049), warranting a cautious clinical interpretation.

CONCLUSION: A significant relationship exists between a high TG/HDL ratio and the presentation of ACS subtypes. These findings suggest that the TG/HDL ratio may be a useful adjunct marker for ACS phenotype stratification when integrated into multivariate models, though its standalone predictive capacity remains weak. Caution is required due to its low discriminatory performance, and further investigation in larger, prospective studies is warranted.