Relationship Between C-Reactive Protein to Albumin Ratio and Infarct-Related Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction
Restricted accessResearch articleFirst published online March, 2022
Relationship Between C-Reactive Protein to Albumin Ratio and Infarct-Related Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction
The C-reactive protein to albumin ratio (CAR) is a predictive marker of systemic inflammatory state in atherosclerotic coronary disease when compared with the predictive value of these 2 markers separately. We investigated the relationship between CAR and infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI). The study population (n = 1047) was divided into 2 groups according to IRA patency which was assessed by the Thrombolysis in Myocardial Infarction (TIMI) flow grade. Nonpatent flow was defined as TIMI grade 0 (no-reflow), 1, and 2 flows, and normal flow was defined as TIMI 3 flow. There was a significant positive correlation between CAR and SYNTAX score (r = 0.312, P < .001) and a negative correlation between CAR and TIMI grade flow (r = −0.210, P < .001). At a cutoff level of 0.693, the CAR predicted TIMI no-reflow with a sensitivity of 65.4% and a specificity of 65.5% (area under the curve: 0.670, 95% CI: 0.62-0.71, P < .001). Multivariate logistic regression analyses showed that CAR was an independent predictor of IRA patency (0.003 [0.001-0.029]; P < .001). A higher CAR is a significant and independent predictor of IRA patency in patients with STEMI.
StoneGWCoxDGarciaE, et al.Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation. 2001;104:636–41.
2.
BrodieBRStuckeyTDHansenCMuncyD. Benefit of coronary reperfusion before intervention on outcomes after primary angioplasty for acute myocardial infarction. Am J Cardiol. 2000;85:13–8.
3.
KrugADu Mesnil deRKorbG. Blood supply of the myocardium after temporary coronary occlusion. Circ Res. 1966;19:57–62.
4.
Group TS. The Thrombolysis in Myocardial Infarction (TIMI) trial. phase I findings. N Engl J Med. 1985;312:932–6.
5.
CelikTBaltaSMikhailidisDP, et al.The Relation Between No-Reflow Phenomenon and Complete Blood Count Parameters. Angiology. 2017;68:381–8.
6.
SpagnoliLGBonannoESangiorgiGMaurielloA. Role of inflammation in atherosclerosis. J Nucl Med. 2007;48:1800–15.
7.
PepysMBBaltzML. Acute phase proteins with special reference to C-reactive protein and related proteins (pentaxins) and serum amyloid A protein. Adv Immunol. 1983;34:141–212.
8.
WilsonAMSwanJDDingH, et al.Widespread vascular production of C-reactive protein (CRP) and a relationship between serum CRP, plaque CRP and intimal hypertrophy. Atherosclerosis. 2007;191:175–81.
9.
RitchieRFPalomakiGENeveuxLMNavolotskaiaOLedueTBCraigWY. Reference distributions for the negative acute-phase serum proteins, albumin, transferrin and transthyretin: a practical, simple and clinically relevant approach in a large cohort. J Clin Lab Anal. 1999;13:273–9.
10.
RencuzogullariIKarabagYCagdasM, et al.Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction. Rev Port Cardiol. 2019;38:269–77.
11.
CagdasMRencuzogullariIKarakoyunS, et al.Assessment of Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Artery Disease Severity in Patients With Acute Coronary Syndrome. Angiology. 2019;70:361–8.
12.
YaylaCGayretli YaylaK. C-Reactive Protein to Albumin Ratio in Patients With Saphenous Vein Graft Disease. Angiology. 2021:3319721998863.
13.
Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J. 2000;21:1502–13.
14.
BaltaSOzturkCBaltaI, et al.The Neutrophil-Lymphocyte Ratio and Inflammation. Angiology. 2016;67:298–9.
15.
MehtaRHHarjaiKJCoxD, et al.Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol. 2003;42:1739–46.
16.
NunezJNunezEBodiV, et al.Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol. 2008;101:747–52.
17.
AkpekMKayaMGUyarelH, et al.The association of serum uric acid levels on coronary flow in patients with STEMI undergoing primary PCI. Atherosclerosis. 2011;219:334–41.
18.
DoganMAkyelABilginM, et al.Can Admission Neutrophil to Lymphocyte Ratio Predict Infarct-Related Artery Patency in ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost. 2013.
19.
CelikTBaltaSOzturkC, et al.Predictors of No-Reflow Phenomenon in Young Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology. 2016;67:683–9.
20.
ScheenAJ. [From atherosclerosis to atherothrombosis: from a silent chronic pathology to an acute critical event]. Rev Med Liege. 2018;73:224–8.
21.
SpinasEKritasSKSagginiA, et al.Role of mast cells in atherosclerosis: a classical inflammatory disease. Int J Immunopathol Pharmacol. 2014;27:517–21.
22.
LaiCLJiYRLiuXHXingJPZhaoJQ. Relationship between coronary atherosclerosis plaque characteristics and high sensitivity C-reactive proteins, interleukin-6. Chin Med J (Engl). 2011;124:2452–6.
23.
KaminskaJKoperOMSiedlecka-CzykierEMatowicka-KarnaJBychowskiJKemonaH. The utility of inflammation and platelet biomarkers in patients with acute coronary syndromes. Saudi J Biol Sci. 2018;25:1263–71.
24.
WangWRenDWangCSLiTYaoHCMaSJ. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019;13:811–20.
25.
HartfordMWiklundOMattsson HultenL, et al.C-reactive protein, interleukin-6, secretory phospholipase A2 group IIA and intercellular adhesion molecule-1 in the prediction of late outcome events after acute coronary syndromes. J Intern Med. 2007;262:526–36.
26.
ZairisMNAdamopoulouENManousakisSJ, et al.The impact of hs C-reactive protein and other inflammatory biomarkers on long-term cardiovascular mortality in patients with acute coronary syndromes. Atherosclerosis. 2007;194:397–402.
27.
AcetHGuzelTAslanBIsikMAErtasFCatalkayaS. Predictive Value of C-Reactive Protein to Albumin Ratio in ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention. Angiology. 2021;72:244–51.
28.
HeeschenCHammCWBruemmerJSimoonsML. Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis. CAPTURE Investigators. Chimeric c7E3 AntiPlatelet Therapy in Unstable angina REfractory to standard treatment trial. J Am Coll Cardiol. 2000;35:1535–42.
29.
LamasGAFlakerGCMitchellG, et al.Effect of infarct artery patency on prognosis after acute myocardial infarction. The Survival and Ventricular Enlargement Investigators. Circulation. 1995;92:1101–9.
30.
CuraFAL’AllierPLKapadiaSR, et al.Predictors and prognosis of suboptimal coronary blood flow after primary coronary angioplasty in patients with acute myocardial infarction. Am J Cardiol. 2001;88:124–8.
31.
MukaiHVillafuerteHQureshiARLindholmBStenvinkelP. Serum albumin, inflammation, and nutrition in end-stage renal disease: C-reactive protein is needed for optimal assessment. Semin Dial. 2018;31:435–9.
32.
MikhailidisDPGanotakisES. Plasma albumin and platelet function: relevance to atherogenesis and thrombosis. Platelets. 1996;7:125–37.
33.
OduncuVErkolAKarabayCY, et al.The prognostic value of serum albumin levels on admission in patients with acute ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention. Coron Artery Dis. 2013;24:88–94.
34.
KurtulAMuratSNYarliogluesM, et al.Usefulness of Serum Albumin Concentration to Predict High Coronary SYNTAX Score and In-Hospital Mortality in Patients With Acute Coronary Syndrome. Angiology. 2016;67:34–40.
35.
KarabagYCagdasMRencuzogullariI, et al.Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. J Clin Lab Anal. 2018;32:e22457.
36.
KalyoncuogluMDurmusG. Relationship between C-reactive protein-to-albumin ratio and the extent of coronary artery disease in patients with non-ST-elevated myocardial infarction. Coron Artery Dis. 2020;31:130–6.
