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Journals / Troia Tıp Dergisi / 2026 / Cilt: 7 Sayı: 2

Association of CRP/albumin ratio with no-reflow in NSTEMI

NSTEMİ’de CRP/albümin oranının no-reflow ile ilişkisi

Muhammet Cihat Çelik(HİTİT ÜNİVERSİTESİ, TIP FAKÜLTESİ)
Macit Kalçık(HITIT UNIVERSITY)
Abdullah Kadir Dolu(İzmir Bakırçay University Çiğili Education and Research Hospita)0000-0002-1142-5974
Orhan Karayiğit(Yozgat City Hospital)0000-0003-0033-4353
Mucahit Yetim(HITIT UNIVERSITY)
Lütfü Bekar(HITIT UNIVERSITY)0000-0002-3920-1382
Pages
70–76
Publication Date
2026-05-31
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Prospective validation is warranted.

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: This study examined the predictive value of the high-sensitivity C-reactive protein/albumin ratio (CAR) for angiographic no-reflow in NSTEMI patients undergoing PCI.
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Key Findings & Data:Methods: We retrospectively evaluated 400 NSTEMI patients treated with PCI between 2021 and 2023.
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Conclusion & Impact:Prospective validation is warranted.
🔬Design:Araştırma Makalesi
📍Scope:2021 Verileri
⚙️Variables:Non–ST elevasyonsuz miyokard enfarktüsü · No-reflow fenomeni · Perkütan koroner girişim

Abstract

Objective: This study examined the predictive value of the high-sensitivity C-reactive protein/albumin ratio (CAR) for angiographic no-reflow in NSTEMI patients undergoing PCI. Methods: We retrospectively evaluated 400 NSTEMI patients treated with PCI between 2021 and 2023. Patients were classified by post-procedural TIMI flow: no-reflow (TIMI ≤2) or normal reflow (TIMI 3). Clinical, laboratory, and angiographic variables were compared. Logistic regression identified independent predictors, and ROC analysis assessed CAR’s discriminative ability. Results: No-reflow occurred in 45 patients (11.3%). Compared with normal reflow, the no-reflow group had higher hs-CRP, lower albumin, and thus elevated CAR (median 0.27 vs. 0.13, p<0.001). Multivariable analysis showed CAR (OR 6.11, 95% CI 2.15–17.38, p=0.001), SYNTAX score, and stent length as independent predictors. ROC analysis demonstrated strong accuracy for CAR (AUC 0.782), exceeding hs-CRP and neutrophil-to-lymphocyte ratio. Conclusion: The hs-CRP/albumin ratio independently predicts angiographic no-reflow in NSTEMI patients undergoing PCI. CAR is inexpensive, widely available, and may support early risk stratification. Prospective validation is warranted.

Özet

Amaç: Bu çalışmada, perkütan koroner girişim yapılan NSTEMI hastalarında yüksek duyarlılıklı C-reaktif protein/albümin oranının (CAR) anjiyografik no-reflow gelişimini öngörmedeki prediktif değeri araştırılmıştır. Yöntem: 2021–2023 yılları arasında PKG ile tedavi edilen 400 NSTEMİ hastası retrospektif olarak değerlendirildi. Hastalar işlem sonrası TIMI akımına göre sınıflandırıldı: no-reflow (TIMI ≤2) ve normal reflow (TIMI 3). Klinik, laboratuvar ve anjiyografik değişkenler karşılaştırıldı. Lojistik regresyon ile bağımsız belirleyiciler saptandı ve ROC analizi CAR’ın ayırt ediciliğini değerlendirdi. Bulgular: No-reflow 45 hastada (%11,3) izlendi. Normal reflow grubuna kıyasla no-reflow grubunda hs-CRP daha yüksek, albümin daha düşük ve buna bağlı olarak CAR daha yüksekti (medyan 0,27 vs. 0,13; p<0,001). Çok değişkenli analizde CAR (OR 6,11; %95 GA 2,15–17,38; p=0,001), SYNTAX skoru ve stent uzunluğu bağımsız öngördürücüler olarak belirlendi. ROC analizi, CAR için yüksek doğruluk gösterdi (AUC 0,782) ve hs-CRP ile nötrofil/lenfosit oranından daha üstün bulundu. Sonuç: Yüksek duyarlıklı CRP/albümin oranı, PKG uygulanan NSTEMİ hastalarında anjiyografik no-reflow fenomenini bağımsız olarak öngörmektedir. CAR düşük maliyetli, yaygın olarak ulaşılabilir olup erken risk sınıflamasını destekleyebilir. Bulguların prospektif çalışmalarla doğrulanması gereklidir.

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Cite This Article

Çelik, M. C., Kalçık, M., Dolu, A. K., Karayiğit, O., Yetim, M., Bekar, L. (2026). Association of CRP/albumin ratio with no-reflow in NSTEMI. Troia Tıp Dergisi, Cilt: 7 Sayı: 2, 70–76. https://doi.org/10.55665/troiamedj.1824706

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References (24)

  1. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-3826.
  2. Ndrepepa G, Tiroch K, Keta D, et al. Predictive factors and impact of no reflow after primary percutaneous coronary intervention in patients with acute myocardial infarction. Circ Cardiovasc Interv. 2010;3(1):27-33.
  3. Niccoli G, Scalone G, Lerman A, Crea F. Coronary microvascular obstruction in acute myocardial infarction. Eur Heart J. 2016;37(13):1024-1033.
  4. Pelliccia F, Niccoli G, Zimarino M, et al. Pathophysiology and Treatment of the No-Reflow Phenomenon in ST-Segment Elevation Myocardial Infarction: Focus on Low-Dose Fibrinolysis during Primary Percutaneous Intervention. Rev Cardiovasc Med. 2023;24(12):365.
  5. Ndrepepa G, Cassese S, Xhepa E, et al. Coronary no-reflow and adverse events in patients with acute myocardial infarction after percutaneous coronary intervention with current drug-eluting stents and third-generation P2Y12 inhibitors. Clin Res Cardiol. 2024;113(7):1006-1016.
  6. Wayne N, Wu Q, Moore SC, Ferrari VA, Metzler SD, Guerraty MA. Multimodality assessment of the coronary microvasculature with TIMI frame count versus perfusion PET highlights coronary changes characteristic of coronary microvascular disease. Front Cardiovasc Med. 2024;11:1395036.
  7. Chia JE, Ang SP. Elevated C-reactive protein and cardiovascular risk. Curr Opin Cardiol. 2025;40(4):237-243.
  8. Tajani A, Sadeghi M, Omidkhoda N, Mohammadpour AH, Samadi S, Jomehzadeh V. The association between C-reactive protein and coronary artery calcification: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2024;24(1):204.
  9. Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med. 2018;52:8-12.
  10. Oduncu V, Erkol A, Karabay CY, 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(2):88-94.
  11. Birdal O. The Relationship Between C-reactive Protein Albumin Ratio and Long-Term Mortality in Patients With Acute Coronary Syndrome. Cureus. 2023;15(10):e47222.
  12. Yang Z, Li Y, Guo T, Yang M, Chen Y, Gao Y. The effect of inflammatory markers on mortality in patients with acute myocardial infarction. Sci Rep. 2025;15(1):14514.
  13. Liu ZY, Tang JN, Cheng MD, et al. C-reactive protein-to-serum albumin ratio as a novel predictor of long-term outcomes in coronary artery disease patients who have undergone percutaneous coronary intervention: analysis of a real-world retrospective cohort study. Coron Artery Dis. 2021;32(3):191-196.
  14. Collet JP, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-1367.
  15. Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1(2):219-227.
  16. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879-888.
  17. Ito H, Maruyama A, Iwakura K, et al. Clinical implications of the 'no reflow' phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation. 1996;93(2):223-228.
  18. Dönmez E, Özcan S, Şahin İ, Okuyan E. Predictors of no-reflow phenomenon development in patients presenting with ST-segment elevated myocardial infarction and treated with primary percutaneous coronary intervention. Bagcilar Med Bull. 2023;8(4):370-77.
  19. Harrison RW, Aggarwal A, Ou FS, et al. Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction. Am J Cardiol. 2013;111(2):178-184.
  20. Kaplangoray M, Toprak K, Aslan R, Deveci E, Gunes A, Ardahanli İ. High CRP-albumin ratio is associated high thrombus burden in patients with newly diagnosed STEMI. Medicine (Baltimore). 2023;102(41):e35363.
  21. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342(12):836-843.
  22. Yarlioglues M, Karacali K, Ilhan BC, Yalcinkaya Oner D. A retrospective study: Association of C-reactive protein and uric acid to albumin ratio with the no-reflow phenomenon in patients with ST elevation myocardial infarction. Int J Cardiol. 2024;397:131621.
  23. Zhang X, Du Y, Guo Q, Ma X, Shi D, Zhou Y. Prognostic value of serum glycated albumin in acute coronary syndrome patients without standard modifiable cardiovascular risk factors. Diabetol Metab Syndr. 2024;16(1):278.
  24. Ridker PM. C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol. 2007;49(21):2129-2138.