Correlation between C-reactive Protein to Albumin and Coronary Collateral Circulation in Patients with Unstable Angina Pectoris

Abstract

Background Coronary collateral circulation (CCC) reduces the degree of myocardial ischemia and improves prognosis of patients with severe coronary artery stenosis, but CCC development varies significantly among different patients. The influencing factors of CCC development still remain clear, but the increase of inflammation response and inflammatory markers is associated with CCC. The C-reactive protein to albumin ratio (CAR) is a newly reported indicator of inflammation, which has been shown in several studies to be superior to C-reactive protein (CRP) and albumin (ALB) in reflecting cardiovascular inflammation. At present, there are few studies on the correlation between CAR level and CCC development. Objective To investigate the correlation between CAR and CCC development in unstable angina pectoris (UAP) patients. Methods One hundred and thirty-five UAP patients who underwent percutaneous coronary intervention during their hospitalization in the Cardiology Department of the First Affiliated Hospital of Soochow University from December 2021 to November 2022 were enrolled as study subjects. The clinical data of the patients were collected and the CCC grade was assessed using the Rentrop grading method. The patients were divided into the well-developed CCC group (Rentrop grade 2-3, n=52) and poor-developed CCC group (Rentrop grade 0-1, n=83) according to the angiographic results. Univariate Logistic regression and multivariate Logistic regression analyses were used to explore the influencing factors of poor-developed CCC in UAP patients. Receiver operating characteristic curves (ROC curves) were plotted to evaluate the predictive value of CRP, ALB and CAR on poor-developed CCC, the area under the ROC curve (AUC) was calculated. Results A total of 135 UAP patients were enrolled, including 87 males and 48 females, with an average age of (65.5±7.1) years. The proportions of diabetes mellitus, smoking, CRP, and CAR of patients in the poor-developed CCC group were significantly higher than the well-developed CCC group (P<0.05) . Multivariate Logistic regression analysis results showed that CAR and diabetes mellitus were influencing factors for poor-developed CCC in UAP patients (P<0.05) . The ROC curve results of CRP, ALB, and CAR in predicting poor-developed CCC showed that the AUC of CRP, ALB, and CAR in predicting poor-developed CCC in UAP patients were 0.771〔95%CI (0.691, 0.851) 〕, 0.745〔95%CI (0.663, 0.851) 〕, 0.813〔95%CI (0.739, 0.886) 〕. The AUC of CAR in predicting poor-developed CCC was higher than CRP (Z=3.869, P<0.001) , ALB (Z=3.044, P=0.002) , the AUC of CRP in predicting poor-developed CCC was higher than ALB (Z=2.000, P=0.046) . Conclusion CAR and diabetes mellitus are influencing factors for poor-developed CCC in UAP patients, elevated CAR level can predict poor-developed CCC with higher predictive value than CRP and ALB.

Keywords

• angina, unstable|blood circulation|collateral circulation|c reactive protein|serum albumin|correlation analysis|root cause analysis