Research Article

Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction

Volume: 52 October 12, 2026
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Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction

Abstract

This study aimed to comparatively evaluate the predictive value of four albumin-based biomarker ratios — C-reactive protein-to-albumin ratio (CAR), platelet-to-albumin ratio (PAR), calcium-to-albumin ratio (CALR), and uric acid-to-albumin ratio (UAR) — for in-stent restenosis (ISR) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). A total of 608 STEMI patients who underwent primary PCI between January 2020 and January 2025 were retrospectively analyzed; the median follow-up was 59.3 months (IQR: 52.5–67.0), and ISR developed in 63 patients (10.4%). The association between the four ratios and restenosis was assessed using univariable and multivariable logistic and Cox regression analyses, receiver operating characteristic (ROC) curve analysis, and restricted cubic spline (RCS) modeling. All four biomarkers were significantly higher in the ISR (+) group and showed significant discriminative ability on ROC analysis (UAR AUC=0.741, CALR AUC=0.710, CAR AUC=0.632, PAR AUC=0.614). All four ratios were independent predictors in multivariable logistic regression; however, in multivariable Cox regression, CAR lost statistical significance (HR=1.28, p=0.071), whereas UAR (HR=2.93, p<0.001), CALR (HR=2.97, p<0.001), and PAR (HR=1.16, p=0.010) remained independent predictors. RCS analysis revealed nonlinear threshold-type relationships for CAR, CALR, and UAR, whereas PAR demonstrated a linear dose-response relationship. In conclusion, CALR and UAR emerged as strong and consistent independent predictors of ISR risk in both cross-sectional and long-term analyses, whereas the predictive value of CAR was largely confined to the cross-sectional assessment

Keywords

References

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Details

Primary Language

English

Subjects

Cardiovascular Medicine and Haematology (Other)

Journal Section

Research Article

Publication Date

October 12, 2026

Submission Date

August 14, 2026

Acceptance Date

September 16, 2026

Published in Issue

Year 2026 Volume: 52

APA
Duygu, A., Er, F., Akgümüş, A., & Balun, A. (2026). Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction. Journal of Uludağ University Medical Faculty, 52. https://doi.org/10.32708/uutfd.2018017
AMA
1.Duygu A, Er F, Akgümüş A, Balun A. Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction. J Uludag Univ Med Fac. 2026;52. doi:10.32708/uutfd.2018017
Chicago
Duygu, Ali, Fahri Er, Alkame Akgümüş, and Ahmet Balun. 2026. “Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction”. Journal of Uludağ University Medical Faculty 52 (October). https://doi.org/10.32708/uutfd.2018017.
EndNote
Duygu A, Er F, Akgümüş A, Balun A (October 1, 2026) Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction. Journal of Uludağ University Medical Faculty 52
IEEE
[1]A. Duygu, F. Er, A. Akgümüş, and A. Balun, “Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction”, J Uludag Univ Med Fac, vol. 52, Oct. 2026, doi: 10.32708/uutfd.2018017.
ISNAD
Duygu, Ali - Er, Fahri - Akgümüş, Alkame - Balun, Ahmet. “Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction”. Journal of Uludağ University Medical Faculty 52 (October 1, 2026). https://doi.org/10.32708/uutfd.2018017.
JAMA
1.Duygu A, Er F, Akgümüş A, Balun A. Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction. J Uludag Univ Med Fac. 2026;52. doi:10.32708/uutfd.2018017.
MLA
Duygu, Ali, et al. “Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction”. Journal of Uludağ University Medical Faculty, vol. 52, Oct. 2026, doi:10.32708/uutfd.2018017.
Vancouver
1.Ali Duygu, Fahri Er, Alkame Akgümüş, Ahmet Balun. Not All Albumin Ratios Are Equal: A Comparative Analysis of Four Biomarkers in Predicting In-Stent Restenosis After ST-Elevation Myocardial Infarction. J Uludag Univ Med Fac. 2026 Oct. 1;52. doi:10.32708/uutfd.2018017

ISSN: 1300-414X, e-ISSN: 2645-9027

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