AIM  To explore the relationship between the ratio of monocyte to high density lipoprotein cholesterol (MHR) and acute ST-segment elevation myocardial infarction (STEMI) and Gensini score, and to explore the predictive value of MHR for STEMI.

  METHODS  Retrospective analysis was made in 132 patients who underwent coronary angiography in the second affiliated hospital of Nanjing Medical University from October 2018 to July 2020 and were diagnosed with STEMI, and 82 patients whose coronary angiography results were normal during the same period served as control group. General data and laboratory examination results were compared between the two groups. Then according to the Gensini score and by three-quantile method, the STEMI group was divided into low-risk group, middle-risk group and high-risk group, and general data and laboratory test results of the three groups were compared. Independent influence factors of STEMI and independent influence factors of high Gensini score were analyzed by univariate and multivariate Logistic regression, and draw receiver operating characteristic curve (ROC) was used to evaluate the predictive value of MHR for high-risk Gensini score in STEMI patients.

  RESULTS  ①The proportions of patients with hypertension (P<0.05) in the STEMI group was higher than that in the control group. The proportions of men, smoke, diabetes, white blood cell count, neutrophils count, monocyte count, creatinine value and MHR in the STEMI group were all higher than those in the control group (all, P<0.01). ②Compared with the low-risk group, the middle-risk group and the higher-risk group had a higher age (P<0.05), an increase in MHR (P<0.01), and an increase in the number of diseased branches (P<0.01); the higher-risk group had an increase neutrophil count (P<0.05), the value of low-density lipoprotein increased (P<0.05). Compared with the middle-risk group, the total cholesterol, MHR, and the number of diseased branches in higher-risk group increased, and the difference was statistically significant (P<0.05). ③Gender, smoking history, and diabetes were independent influence factors for STEMI. ④Low-density lipoprotein, MHR, and the number of lesions were independent risk factors for the high risk of Gensini score. ⑤ROC curve showed that when the MHR cut-off value was 0.469, the diagnostic value of the high risk of Gensini score of STEMI patients was the highest (sensitivity 75.0%, specificity 71.9%, area under the curve 0.750, 95%CI: 0.671～0.827, P<0.01).

  CONCLUSION  ①MHR is not an independent influencing factor of the occurrence of STEMI, but an independent influencing factor of the high-risk Gensini score of STEMI patients, which can be used clinically as an index to predict high-risk STEMI patients. ②When MHR>0.469, the Gensini score of STEMI patients has the most predictive value, and it can be used as a cutoff value of high-risk STEMI patients.