The Correlation of Clinical, Lipid- and Inflammation-Based Indices with Gensini Score in Young NSTEMI Patients

Background/Objectives: Lipid-derived and lymphocyte-based inflammatory indices (LBIIs) are studied in coronary artery disease (CAD), but their relationship with angiographic burden in patients aged ≤45 years with non-ST-elevation myocardial infarction (NSTEMI) remains unclear. We evaluated clinical, laboratory, lipid-derived, and LBII correlates of the Gensini score. Methods: In this retrospective cross-sectional study, 402 troponin-positive NSTEMI patients undergoing coronary angiography were screened; 288 of them were eligible. Univariable associations were assessed using Spearman correlations with Benjamini–Hochberg false-discovery-rate (FDR) correction. Multivariable linear regression of log2 (Gensini + 1), with HC3-robust standard errors, included 281 complete cases. The selection of CRI-2 after inspection of the univariable results was exploratory rather than prespecified. Raw, square-root, and median models assessed sensitivity. Results: Mean age was 40.7 ± 4.1 years; 83.3% of patients were male and 76.0% were current smokers, and median Gensini score was 32.0 (IQR 9.4–58.1). Multivariable analysis showed greater burden with current smoking (+114.3%, p < 0.001), male sex (+90.1%, p = 0.013), each 5-year age increase (+33.9%, p = 0.009), and each 1-unit Castelli risk index-2 (CRI-2) increase (+23.3%, p = 0.009); a 5-percentage-point left ventricular ejection fraction (LVEF) increase was associated with an 18.4% lower burden (p = 0.001). None of the five LBIIs showed a statistically significant association with the continuous Gensini score after Benjamini–Hochberg FDR correction in univariable screening. Smoking, sex, age, and LVEF remained consistent across scales, whereas CRI-2 was statistically significant in the log2-transformed and square-root-transformed models but not in the raw and median models. Conclusions: In young patients with NSTEMI, smoking, male sex, older age, and higher CRI-2 were associated with greater coronary atherosclerotic burden, whereas none of the examined LBIIs showed a statistically significant association with coronary atherosclerotic burden after FDR correction. These findings reinforce the importance of smoking cessation and guideline-directed lipid management in secondary prevention.