AIMS Recently, a novel metabolic indicator, the Waist-to-Height-Haemoglobin A1c (WHH) index, has been shown to be associated with diabetes risk. This study investigated the association of WHH with the Cardiac Infarction/Injury Score (CIIS) and the risk of subclinical myocardial injury (SC-MI), stratified by hypertension status. METHODS We conducted a cross-sectional analysis of 5,597 adults aged ≥40 years from the Third National Health and Nutrition Examination Survey who were free of CVD. The WHH index was calculated as waist circumference/height × HbA1c. SC-MI was defined as a CIIS ≥10 on a 12-lead electrocardiogram. Using weighted generalised linear and logistic regression models, we examined the associations of WHH with CIIS and SC-MI. Nonlinear relationships were assessed using restricted cubic spline (RCS) models. RESULTS The WHH index was not associated with SC-MI among adults without hypertension (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.73-1.24 per SD increase), but was positively associated among adults with hypertension (OR, 1.37; 95% CI, 1.08-1.72; Pinteraction = 0.007). For the CIIS, each 1-SD higher WHH index was positively associated only among those with hypertension (β = 0.81; 95% CI, 0.12 to 1.63; Pinteraction = 0.020). RCS analysis confirmed a linear relationship between WHH and SC-MI risk among individuals with hypertension. CONCLUSIONS These findings demonstrate a significant association between the WHH index and subclinical myocardial injury, particularly among adults with hypertension.
BACKGROUND Percutaneous coronary intervention (PCI) has emerged as an established revascularization strategy for selected patients with left main coronary artery (LMCA) disease. However, data regarding outcomes in unselected real-world populations and the impact of intravascular imaging remain limited. We aimed to evaluate clinical outcomes following LMCA PCI according to clinical presentation and to assess the prognostic impact of intravascular imaging guidance. METHODS We conducted a retrospective single-centre study including consecutive patients undergoing LMCA PCI between 2019 and 2022. Patients were classified as having chronic (CCS) or acute coronary syndrome (ACS). Major adverse cardiac and cerebrovascular events (MACCE) were assessed during follow-up. Kaplan-Meier and Cox regression and stabilised inverse probability of treatment weighting (SIPTW) analyses were performed. RESULTS A total of 107 patients were included (19 CCS and 88 ACS; mean age 68.6 ± 11.3 years; 80.4% male). During a mean follow-up of 1121 ± 574 days, ACS patients experienced higher rates of MACCE (40.9% vs. 15.8%; p = 0.039) and all-cause mortality (29.5% vs. 5.3%; p = 0.027) compared with CCS patients. Intravascular imaging-guided PCI was associated with a significantly lower risk of MACCE in multivariable analysis (HR 0.32, 95% CI 0.14-0.75; p = 0.009). In a SIPTW-adjusted analysis, the association remained directionally favourable, although statistical significance was not maintained (HR 0.57, 95% CI 0.26-1.29; p = 0.178). CONCLUSIONS Clinical presentation significantly influences outcomes after LMCA PCI, with worse long-term prognosis among ACS patients. Intravascular imaging-guided PCI was associated with lower rates of MACCE and remained directionally favourable after weighting analyses, supporting its role in optimising LMCA interventions.
