Admission platelet-to-hemoglobin ratio and 1-year outcomes after percutaneous coronary intervention: a multicenter registry cohort study
- 1Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkwang University Hospital , ,
Abstract
Background: The platelet-to-hemoglobin ratio (PHR) is a proposed prognostic marker in cardiovascular disease, but it has not been evaluated against a broad major adverse cardiovascular events (MACE) endpoint in a dedicated percutaneous coronary intervention (PCI) cohort, and whether it adequately summarizes its two components remains untested.
Methods: We analyzed 1,551 patients pooled from two prospective Korean drug-eluting stent registries (2016–2022). The PHR was calculated as platelet count (×10⁹/L) divided by hemoglobin (g/L). The primary endpoint was 1-year MACE, with follow-up censored at 365 days, a composite of all-cause death, myocardial infarction, stroke, repeat revascularization, or heart failure hospitalization. Multivariable Cox models included eight prespecified clinical covariates; the functional form was examined with restricted cubic splines, and the PHR was decomposed using nested models and a log-scale ratio-constraint test.
Results: MACE occurred in 107 patients (6.9%) within 1 year. A higher PHR was independently associated with MACE (adjusted hazard ratio [HR] per 1-standard deviation, 1.21; 95% confidence interval [CI], 1.05–1.40; P = 0.008), with no evidence of nonlinearity ( P = 0.700). Adding the PHR improved the clinical model (likelihood-ratio P = 0.013); the ratio constraint was not rejected ( P = 0.765), and a single log-PHR term retained 98.7% of the two-component likelihood-ratio χ ² increment over the clinical model in this cohort (bootstrap 95% CI, 21.8%–100%). The PHR was associated with all-cause and cardiovascular death (both HR, 1.28), paralleling hemoglobin. Repeat revascularization was associated with platelet count (HR, 1.39; P = 0.014), but not significantly with PHR (HR, 1.24; P = 0.081). Risk was concentrated in patients with both anemia and a platelet count at or above the median (adjusted HR, 1.82; 95% CI, 1.05–3.15). The gain in discrimination was negligible ( Δ AUC, +0.003; 95% CI, −0.003 to +0.012), and net benefit was virtually unchanged.
Conclusions: The admission PHR was independently associated with 1-year MACE after PCI, with no evidence of nonlinearity, and its log-scale component effects were compatible with the ratio constraint in this cohort. Given the negligible gain in discrimination and net benefit, the PHR is an independent prognostic marker rather than a tool for risk reclassification.
Registry registration: Clinical Research Information Service KCT0003392 and KCT0005008.
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BibTeX
@article{byoun2026admission,
title = {{Admission platelet-to-hemoglobin ratio and 1-year outcomes after percutaneous coronary intervention: a multicenter registry cohort study}},
author = {Jeong Tae Byoun and Donghyeon Joo and Sungho Jo and Jae Young Cho and Kyeong Ho Yun},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1981126},
url = {https://europepmc.org/article/PMC/PMC13690651},
note = {CC BY},
}
RIS
TY - JOUR
TI - Admission platelet-to-hemoglobin ratio and 1-year outcomes after percutaneous coronary intervention: a multicenter registry cohort study
AU - Jeong Tae Byoun
AU - Donghyeon Joo
AU - Sungho Jo
AU - Jae Young Cho
AU - Kyeong Ho Yun
PY - 2026
DA - 2026/10/09
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1981126
UR - https://europepmc.org/article/PMC/PMC13690651
AB - Background: The platelet-to-hemoglobin ratio (PHR) is a proposed prognostic marker in cardiovascular disease, but it has not been evaluated against a broad major adverse cardiovascular events (MACE) endpoint in a dedicated percutaneous coronary intervention (PCI) cohort, and whether it adequately summarizes its two components remains untested. Methods: We analyzed 1,551 patients pooled from two prospective Korean drug-eluting stent registries (2016–2022). The PHR was calculated as platelet count (×10⁹/L) divided by hemoglobin (g/L). The primary endpoint was 1-year MACE, with follow-up censored at 365 days, a composite of all-cause death, myocardial infarction, stroke, repeat revascularization, or heart failure hospitalization. Multivariable Cox models included eight prespecified clinical covariates; the functional form was examined with restricted cubic splines, and the PHR was decomposed using nested models and a log-scale ratio-constraint test. Results: MACE occurred in 107 patients (6.9%) within 1 year. A higher PHR was independently associated with MACE (adjusted hazard ratio [HR] per 1-standard deviation, 1.21; 95% confidence interval [CI], 1.05–1.40; P = 0.008), with no evidence of nonlinearity ( P = 0.700). Adding the PHR improved the clinical model (likelihood-ratio P = 0.013); the ratio constraint was not rejected ( P = 0.765), and a single log-PHR term retained 98.7% of the two-component likelihood-ratio χ ² increment over the clinical model in this cohort (bootstrap 95% CI, 21.8%–100%). The PHR was associated with all-cause and cardiovascular death (both HR, 1.28), paralleling hemoglobin. Repeat revascularization was associated with platelet count (HR, 1.39; P = 0.014), but not significantly with PHR (HR, 1.24; P = 0.081). Risk was concentrated in patients with both anemia and a platelet count at or above the median (adjusted HR, 1.82; 95% CI, 1.05–3.15). The gain in discrimination was negligible ( Δ AUC, +0.003; 95% CI, −0.003 to +0.012), and net benefit was virtually unchanged. Conclusions: The admission PHR was independently associated with 1-year MACE after PCI, with no evidence of nonlinearity, and its log-scale component effects were compatible with the ratio constraint in this cohort. Given the negligible gain in discrimination and net benefit, the PHR is an independent prognostic marker rather than a tool for risk reclassification. Registry registration: Clinical Research Information Service KCT0003392 and KCT0005008.
SN - 2297-055X
ER -