Predictive value of platelet/albumin ratio in coronary slow-flow patients

Yıl 2024, Cilt: 5 Sayı: 6, 304 - 308, 23.12.2024

Yunus Emre Yavuz , Sefa Tatar , Muzaffer Aslan

Öz

Aims:The pathophysiology of coronary slow flow is not yet fully understood, and it is thought to be related to multiple mechanisms such as endothelial dysfunction, microvascular disorder, and atherosclerosis. In this study, we aimed to investigate the predictive value of platelet/albumin ratio (PAR) in coronary slow flow patients (CSF). In addition, we compared it with other current parameters containing albumin.
Methods: The study was designed retrospectively. The study population included a review of the medical records of 260 people who underwent coronary angiography from 2020 to 2023. The study groups consisted of 108 patients with coronary slow flow and 101 patients with normal coronary arteries who met the inclusion criteria. Various parameters such as demographic data, Platelet/Albumin Ratio and prognostic nutritional index were compared between these two groups. ROC analysis was performed on these parameters.
Results: There was no significant difference between the coronary slow flow and control groups in terms of basic demographic characteristics such as age, gender and smoking, but BMI (p<0.001), LDL (p:0.026) and total cholesterol (p:0.041) ratios were higher in the coronary slow flow group. PAR showed a significant difference between the coronary slow flow group and the control group (p:0.022). Prognostic nutritional index was not significant (p:0.142). ROC curve analysis for the PAR showed a moderate discriminatory ability with an area under the curve (ROC) of 0.592 (95% CI: 0.517-0.667). Conversely, the prognostic nutritional index exhibited limited diagnostic performance with an AUC of 0.441 (95% CI: 0.365-0.522).
Conclusion: These findings suggest that easily measurable PAR may be a valuable biomarker in assessing coronary slow flow, especially in resource-limited settings. Not only does PAR demonstrate a discriminatory ability, but it also outperforms other traditional biomarkers like the prognostic nutritional index (PNI) in this specific patient population.

Anahtar Kelimeler

Coronary angiography, blood platelets, albumin, coronary slow flow

Etik Beyan

Ethics Committee Approval: The study received ethical approval from the research committee of Siirt Training and Research Hospital on December 14, 2023, with reference number 94582.

Koroner Yavaş Akım Hastalarında Trombosit/Albümin Oranının Prediktif Değeri

Öz

Amaç
Koroner yavaş akımın patofizyolojisi henüz tam olarak anlaşılamamıştır ve endotel disfonksiyonu, mikrovasküler bozukluk ve ateroskleroz gibi birçok mekanizma ile ilişkili olduğu düşünülmektedir. Bu çalışmada koroner yavaş akım hastalarında Trombosit/Albümin Oranının prediktif değerini araştırmayı amaçladık. Ek olarak, albümin içeren diğer güncel parametrelerle karşılaştırdık.

Yöntemler
Çalışma retrospektif olarak tasarlandı. Çalışma popülasyonu 2020'den 2023'e kadar koroner anjiyografi yapılan 260 kişinin tıbbi kayıtlarının gözden geçirilmesini içeriyordu. Çalışma grupları, çalışmaya dahil edilme kriterlerine uyan 108 koroner yavaş akım hastası ve koroner arterleri normal olan 101 hastadan oluşuyordu. Bu iki grup arasında demografik veriler, Trombosit/Albümin Oranının ve prognostik beslenme indeksi gibi çeşitli parametreler karşılaştırıldı. Bu parametreler üzerinde ROC analizi yapıldı.

Bulgular
Koroner yavaş akım ve kontrol gruplarının temel özellikleri arasında; yaş, cinsiyet ve sigara kullanımı gibi temel demografik özellikler açısından anlamlı bir fark yoktu, ancak koroner yavaş akım grubunda BMİ (p<0,001), LDL (p:0,026) ve total kolesterol (p:0,041) oranları daha yüksekti. Trombosit/Albümin Oranı, koroner yavaş akım grubu ile kontrol grubu arasında anlamlı bir fark gösterdi (p:0.022). Prognostik beslenme indeksi anlamlı değildi (p:0.142). Trombosit/Albümin Oranı için ROC eğrisi analizi, 0.592 (%95 CI: 0.517-0.667) eğrinin altındaki bir alanla (ROC) orta derecede ayırt edici bir yetenek gösterdi. Tersine, prognostik beslenme indeksi 0.441 AUC ile sınırlı tanısal performans sergiledi (% 95 CI: 0.365-0.522).

Sonuç
Bu bulgular, kolayca ölçülebilir Trombosit/Albümin oranının, özellikle kaynak sınırlı ortamlarda, koroner yavaş akışın değerlendirilmesinde değerli bir biyobelirteç olabileceğini düşündürmektedir. Trombosit/Albümin oranının sadece ayırt edici bir yetenek göstermekle kalmaz, aynı zamanda bu spesifik hasta popülasyonunda prognostik beslenme indeksi gibi diğer geleneksel biyobelirteçlerden daha iyi performans gösterir.

Anahtar Kelimeler

Koroner anjiyografi, trombosit, albümin, koroner yavaş akım

Kaynakça

• Wang X, Nie Sh. The coronary slow flow phenomenon: characteristics, mechanisms, and implications. Cardiovasc Diagn Ther. 2011;1(1):37-43.
• Yilmaz H, Demir I, Uyar Z. Clinical and coronary angiographic characteristics of patients with coronary slow flow. Acta Cardiol. 2008;63(5): 579-584.
• Tanriverdi H, Evrengul H, Enli Y, et al. Effect of homocysteine-induced oxidative stress on endothelial function in coronary slow-flow. Cardiology. 2007;107(4):313-320.
• Alvarez C, Siu H. Coronary slow-flow phenomenon as an underrecognized and treatable source of chest pain: case series and literature review. J Investig Med High Impact Case Rep. 2018;6:2324709618789194.
• Beltrame JF. Defining the coronary slow flow phenomenon. Circ J. 2012; 76(4):818-820.
• Li JJ, Wu YJ, Xue-Wen XW. Should slow coronary flow be considered as a coronary syndrome? Med Hypotheses. 2006;66(5):953-956.
• Sezgin AT, Barutcu I, Sezgin N, et al. Contribution of plasma lipid disturbances to vascular endothelial function in patients with slow coronary flow. Angiology. 2006;57(6):694-701.
• Camsari A, Pekdemir H, Ciçek D, et al. Endothelin-1 and nitric oxide concentrations and their response to exercise in patients with slow coronary flow. Circ J. 2003;67(12):1022-1028.
• Pekdemir H, Cin VG, Cicek D, et al. Slow coronary flow may be a sign of diffuse atherosclerosis. Contribution of FFR and IVUS. Acta Cardiol. 2004; 59(2):127-133.
• Arroyo V, Garcia-Martinez R, Salvatella X. Human serum albumin, systemic inflammation, and cirrhosis. J Hepatol. 2014;61(2):396-407.
• Li T, Li X, Wei Y, et al. Predictive value of c-reactive protein-to-albumin ratio for neonatal sepsis. J Inflamm Res. 2021;14:3207-3215.
• Babat N, Kaya Y, Demir H. Correlation IMA with TIMI frame count in slow coronary flow: can it be a guide for treatment? Aging Male. 2020;23(5):635-640.
• Peters RJ, Moons AH. Platelet function and coronary artery disease. Eur J Clin Invest. 2001;31(1):3-5.
• Shirai Y, Shiba H, Haruki K, et al. Preoperative platelet-to-albumin ratio predicts prognosis of patients with pancreatic ductal adenocarcinoma after pancreatic resection. Anticancer Res. 2017;37(2):787-793.
• Hao P, Feng S, Suo M, et al. Platelet to albumin ratio: a risk factor related to prognosis in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. Int J Cardiol. 2024;395:131588.
• Şahin DY, Gür M, Elbasan Z, et al. Mean platelet volume associated with aortic distensibility, chronic inflammation, and diabetes in patients with stable coronary artery disease. Clin Appl Thromb Hemost. 2014;20(4):416-421.
• Ozyurtlu F, Yavuz V, Cetin N et al. The association between coronary slow flow and platelet distribution width among patients with stable angina pectoris. Postepy Kardiol Interwencyjnej. 2014;10(3):161-165.
• Demirkiran A, Aydin C. Relationship between uric acid/albumin ratio and coronary slow flow. European Res J. (2023);9(5):1171-1177.
• Aksoy F. Do neutrophil lymphocyte and platelet-lymphocyte ratios determine surgical treatment method in peptic ulcer? Selçuk Tıp Dergisi. 2016;32(3):56-57.
• He Z, Wang H, Wang S, Li L. Predictive value of platelet-to-albumin ratio (PAR) for the cardiac-associated acute kidney injury and prognosis of patients in the intensive care unit. Int J Gen Med. 2022;15:8315-8326.
• Gökmen F,Türkön H,Akbal A et al. The relationship between inflammatory parameters and atherosclerosis with ischemic modified albumin levels in Sjögren syndrome. Selçuk Tıp Dergisi. 2014;31(1):20-23.
• Durgut H, Ozer SB, Kucukkartallar T. Role of ischemia-modified albumin in early diagnosis of acute mesenteric ischemia in rats. Selcuk Med J. 2018; 34(2):55-59.
• Zhang S, Wang H, Chen S, et al. Prognostic nutritional index and prognosis of patients with coronary artery disease: a systematic review and meta-analysis. Front Nutr. 2023;10:1114053.
• Li T, Yuan D, Wang P, et al. Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease: a cohort study. Diabetol Metab Syndr. 2023;15(1):58.
• Huang Y, Zhang Q, Li P, et al. The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction. BMC Cardiovasc Disord. 2023;23(1):339.