Tüm Albümin Oranları Eşit Değildir: ST Elevasyonlu Miyokard Enfarktüsü Sonrası Stent İçi Restenoz Öngörüsünde Dört Biyobelirtecin Karşılaştırmalı Analizi

Öz

Bu çalışmanın amacı, ST-elevasyonlu miyokard enfarktüsü (STEMI) nedeniyle birincil perkütan koroner girişim (PCI) uygulanan hastalarda, dört albümin temelli biyobelirteç oranının — CRP/albümin oranı (CAR), trombosit/albümin oranı (PAR), kalsiyum/albümin oranı (CALR) ve ürik asit/albümin oranı (UAR) — in-stent restenoz (ISR) gelişimini öngörmedeki karşılaştırmalı değerini araştırmaktır. Ocak 2020–Ocak 2025 tarihleri arasında birincil PCI uygulanan 608 STEMI hastası retrospektif olarak değerlendirildi; ortanca takip süresi 59,3 ay (IQR: 52,5–67,0) olup 63 hastada (%10,4) ISR gelişti. Dört oranın restenoz ile ilişkisi univariable ve multivariable lojistik ve Cox regresyon analizleri, ROC eğrisi analizi ve kısıtlı kübik spline (RCS) modellemesiyle değerlendirildi. Dört biyobelirteç de restenoz (+) grupta anlamlı olarak yüksekti ve ROC analizinde anlamlı ayırt edicilik gösterdi (UAR AUC=0,741, CALR AUC=0,710, CAR AUC=0,632, PAR AUC=0,614). Çok değişkenli lojistik regresyonda dört oran da bağımsız prediktördü; ancak çok değişkenli Cox regresyon analizinde CAR anlamlılığını kaybederken (HR=1,28, p=0,071), UAR (HR=2,93, p<0,001), CALR (HR=2,97, p<0,001) ve PAR (HR=1,16, p=0,010) bağımsız prediktör olma özelliğini korudu. RCS analizinde CAR, CALR ve UAR doğrusal olmayan (eşik-tipi), PAR ise doğrusal bir doz-yanıt ilişkisi gösterdi. Sonuç olarak, CALR ve UAR hem kesitsel hem uzun dönem ISR riskinin güçlü ve tutarlı bağımsız prediktörleri olarak öne çıkarken, CAR'ın prediktif değeri esas olarak kesitsel değerlendirmeyle sınırlı kalmıştır.

Anahtar Kelimeler

• ST elevasyonlu miyokard enfarktüsü
• koroner restenoz
• serum albümin
• C-reaktif protein
• ürik asit

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

Öz

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

Anahtar Kelimeler

• ST elevation myocardial infarction
• coronary restenosis
• serum albumin
• C-reactive protein
• uric acid

Kaynakça

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