Predictive Value of C-Reactive Protein to Albumin Ratio in ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention
Restricted accessResearch articleFirst published online March, 2021
Predictive Value of C-Reactive Protein to Albumin Ratio in ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention
The present study aimed to examine the association of C-reactive protein to albumin ratio (CAR) with short-term major adverse cardiac events (MACEs) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). We included 539 STEMI patient treated with pPCI in this study. Patients were divided into 2 groups according to MACE development. Patients with MACE had higher CAR than those without (1.18 [0.29-1.99] vs 0.21 [0.09-0.49], P < .001). Multivariate analysis showed that The Global Record for Acute Coronary Events score, Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score, glucose and CAR (odds ratio:1.326, 95% CI: 1.212-1452, P < .001) were independent predictors of MACE. The CAR may be proven useful for risk stratification in STEMI patients undergoing pPCI.
PedersenFButrymovichVKelbækH, et al.Short- and long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol. 2014;64:2101–8.
2.
EagleKALimMJDabbousOH, et al.; GRACE Investigators. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month post discharge death in an international registry. JAMA. 2004;291:2727–33.
3.
KeelyECBouraJAGrinesCL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials. Lancet. 2003;361:13–20.
4.
SchalkBVisserMBremmerMPenninxBBouterLDeegD. Change of serum albumin and risk of cardiovascular disease and all-cause mortality: longitudinal aging study Amsterdam. Am J Epidemiol. 2006;164:969–77.
5.
DaneshJCollinsRApplebyPPetoR. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 1998;279:1477–82.
6.
YavuzKarabağMetinÇağdaşIbrahim Rencuzogullari, et al.Usefulness of The C-Reactive Protein/Albumin Ratio for Predicting No-Reflow in ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Eur J Clin Invest. 2018;48(6):e12928.
7.
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.
8.
KarabagYCagdaşMRencuzogullariI, 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.
9.
WangWRenDWangCSLiTYaoHCMaSJ. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019;13:811–20.
10.
NeumannFJSousa-UvaMAhlssonA, et al.2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40:87–165.
11.
DeLongERDeLongDMClarke-PearsonDL. Comparing THE areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics.1988;44:837–45.
12.
PencinaMJD’AgostinoRBSrSteyerbergEW. Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med. 2011;30:11–21.
13.
LibbyP. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2001;104:365–72.
14.
VarnavaAMMillsPGDaviesMJ. Relationship between coronary artery remodeling and plaque vulnerability. Circulation. 2002;105:939–43.
15.
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.
16.
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.
17.
De ServiSMarianiMMarianiGMazzoneA. C-reactive protein increase in unstable coronary disease cause or effect?J Am Coll Cardiol. 2005;46:1496–502.
18.
JamesSKLindahlBSiegbahnA, et al.N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies to Open occluded arteries (GUSTO)-IV substudy. Circulation. 2003;108:275–81.
19.
MorrowDARifaiNAntmanEM, et al.C-reactive protein is a potent predictor of mortality independently of and in combination with troponin T in acute coronary syndromes: a TIMI 11A substudy. Thrombolysis in Myocardial Infarction. J Am Coll Cardiol. 1998;31:1460–65.
20.
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.
21.
ZairisMNLyrasAGBibisGP, et al.Association of inflammatory biomarkers and cardiac troponin I with multifocal activation of coronary artery tree in the setting of non-ST-elevation acute myocardial infarction. Atherosclerosis. 2005;182:161–7.
22.
SuleimanMAronsonDReisnerSA, et al.Admission C-reactive protein levels and 30-day mortality in patients with acute myocardial infarction. Am J Med. 2003;115:695–701.
23.
LasaveLIAbizaidAAPaiva e MaiaJ, et al.Relationship between plasma C-reactive protein level and neointimal hyperplasia volume in patients with zotarolimus-eluting stents. Volumetric analysis by three-dimensional intracoronary ultrasound. Rev Esp Cardiol. 2007;60:923–31.
24.
ChengJMOemrawsinghRMGarcia-GarciaHM, et al.Relation of C-reactive protein to coronary plaque characteristics on grayscale, radiofrequency intravascular ultrasound, and cardiovascular outcome in patients with acute coronary syndrome or stable angina pectoris (from the ATHEROREMO-IVUS study). Am J Cardiol. 2014;114:1497–03.
25.
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.
26.
KurtulAOcekAHMuratSN, et al.Serum albumin levels on admission are associated with angiographic no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Angiology. 2015;66:278–85.
27.
RocheMRondeauPSinghNRTarnusEBourdonE. The antioxidant properties of serum albumin. FEBS Lett. 2008;582:1783–7.
28.
PlakhtYGilutzHShiyovichA.Decreased admission serum albumin level is an independent predictor of long-term mortality in hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction II (SAMI-II) project. Int J Cardiol. 2016;219:20–4.
29.
NicholsonJPWolmaransMRParkGR. The role of albumin in critical illness. Br J Anaesth. 2000;85:599–610.
30.
DonBRKaysenG.Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004;17:432–7.
31.
DasUN. Albumin and lipid enriched albumin for the critically ill. J Assoc Physicians India. 2009;57:53–9.
32.
DasUN. Albumin infusion for the critically ill–is it beneficial and, if so, why and how?Crit Care. 2015;19:156.
33.
DasUN. Albumin to globulin ratio and/or plasma albumin in predicting long-term mortality. Am J Surg. 2014;208:157–8.
34.
OhJKimSHParkKN, et al.High-sensitivity C-reactive protein/albumin ratio as a predictor of in-hospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med. 2017;4:19–24.
35.
XieQZhouYXuZ, et al.The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury. BMC Nephrol. 2011;12:30.
36.
RanzaniOTZampieriFGForteDNAzevedoLCParkM. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE. 2013;8:e59321.
37.
CaixetaAGénéreuxPPalmeriniT, et al.Prognostic utility of the SYNTAX score in patients with single versus multivessel disease undergoing percutaneous coronary intervention (from the Acute Catheterization and Urgent Intervention Triage StrategY [ACUITY]trial). Am J Cardiol. 2014;113:203-10.
38.
ParenicaJKalaPPavkovaMG, et al.Natriuretic peptides, nitrite/nitrate and superoxide dismutase have additional value on top of the GRACE score in prediction of one-year mortality and rehospitalisation for heart failure in STEMI patients - Multiple biomarkers prospective cohort study. Int J Cardiol. 2016;211:96–104.
39.
KlingenbergRAghlmandiSRäberL, et al.Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score. Eur Heart J Acute Cardiovasc Care. 2016;7;129–138.
