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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The study presented by Rencuzogullari et al&#46; in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> is part of the large and important body of evidence on the role of inflammation in cardiovascular disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#8211;5</span></a> The authors aimed to investigate the ability of the ratio between serum levels of two important acute-phase proteins&#44; C-reactive protein &#40;CRP&#41; and albumin&#44; to predict in-stent restenosis&#46; There is already an extensive literature on the association between CRP and cardiovascular risk&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#8211;8</span></a> but its ability to predict acute coronary syndromes is modest&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9&#8211;11</span></a> A positive relationship between elevated serum CRP levels and in-stent restenosis&#44; the clinical focus of the study under consideration&#44; has also been established&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a> At the same time&#44; reduced serum concentrations of albumin have been related to increased cardiovascular risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">13&#44;14</span></a> Furthermore&#44; the CRP&#47;albumin ratio has been associated with worse prognosis in cancer<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> and can be used as a simple predictor of poor overall health&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">From a clinical standpoint&#44; assessment of the combination of increased CRP and decreased albumin levels makes sense&#44; seeing that these two molecules are involved in a range of complex and frequently interlinked processes ranging from inflammation to malnutrition&#44; and so in theory the ratio between them should have considerable potential as a prognostic marker&#46; However&#44; Rencuzogullari et al&#46; run a risk by attempting to associate this ratio with in-stent restenosis &#40;a serious albeit uncommon complication of percutaneous revascularization<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&#41; since&#44; like all indices of inflammatory markers used in cardiovascular assessment&#44; it is non-specific&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study is retrospective&#44; reviewing around six years of data from a single institution&#46; The population was of patients with ST-segment elevation myocardial infarction who underwent coronary angiography and percutaneous coronary intervention following standard indications&#46; Of these&#44; 448 who underwent repeat angiography due to recurrence of anginal symptoms were included in the study&#44; of whom 25&#37; &#40;110&#47;448&#41; presented in-stent restenosis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Unfortunately&#44; the study did not use high-sensitivity CRP assays&#44; which are firmly established in the literature as the gold standard for assessing vascular inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> The authors acknowledge that their use of an older test&#44; which is less sensitive and more likely to be influenced by rises in CRP due to non-vascular causes&#44; is a limitation to their study&#46; Their results also include a wide range of laboratory results&#44; from lipid profile to platelet count&#44; as well as platelet distribution width&#44; which is associated with myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> The study thus has the characteristics of a general review of in-stent restenosis&#44; even though drug-eluting stents&#44; which were designed to be less prone to restenosis&#44; were not used&#46; This limitation was also pointed out by the authors&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study concludes that the CRP&#47;albumin ratio is a better predictor than CRP or albumin individually&#44; at least in bare-metal stents&#46; Overall&#44; the work has merit&#44; especially in the emphasis it places on the use of inflammatory parameters in clinical practice&#46; However&#44; despite recent successes in proof-of-concept trials&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> and although inflammation has been the focus of much productive and challenging basic and clinical research over the last twenty years&#44; there is still some way to go before all the accumulated evidence can be brought to bear on daily clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">To conclude&#44; despite its limitations&#44; the paper under consideration adds another small piece to the puzzle in this challenging area in which research continues apace&#44; even though its conclusions need to be confirmed by further studies&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Bronze L&#46; A rela&#231;&#227;o da prote&#237;na <span class="elsevierStyleSmallCaps">C</span>-reativa&#47;albumina na avalia&#231;&#227;o do risco de reestenose de stent&#58; mais uma pequena pe&#231;a no vasto puzzle da inflama&#231;&#227;o vascular&#46; Rev Port Cardiol&#46; 2019&#59;38&#58;279&#8211;280&#46;</p>"
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Editorial comment
C-Rreactive protein/albumin ratio in the assessment of risk for in-stent restenosis: Another small piece in the puzzle of vascular inflammation
A relação da proteína C-reativa/albumina na avaliação do risco de reestenose de stent: mais uma pequena peça novasto puzzle da inflamação vascular
Luís Bronzea,b,c,
Corresponding author
a Cardiologista, Marinha Portuguesa, Lisboa, Portugal
b Linha de Saúde, Centro de Investigação Naval (Cinav), Marinha Portuguesa, Lisboa, Portugal
c Professor Auxiliar, Mestrado Integrado de Medicina, Universidade da Beira Interior, Covilhã, Portugal
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        "titulo" => "A rela&#231;&#227;o da prote&#237;na <span class="elsevierStyleSmallCaps">C</span>-reativa&#47;albumina na avalia&#231;&#227;o do risco de reestenose de stent&#58; mais uma pequena pe&#231;a novasto puzzle da inflama&#231;&#227;o vascular"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The study presented by Rencuzogullari et al&#46; in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> is part of the large and important body of evidence on the role of inflammation in cardiovascular disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#8211;5</span></a> The authors aimed to investigate the ability of the ratio between serum levels of two important acute-phase proteins&#44; C-reactive protein &#40;CRP&#41; and albumin&#44; to predict in-stent restenosis&#46; There is already an extensive literature on the association between CRP and cardiovascular risk&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#8211;8</span></a> but its ability to predict acute coronary syndromes is modest&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">9&#8211;11</span></a> A positive relationship between elevated serum CRP levels and in-stent restenosis&#44; the clinical focus of the study under consideration&#44; has also been established&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a> At the same time&#44; reduced serum concentrations of albumin have been related to increased cardiovascular risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">13&#44;14</span></a> Furthermore&#44; the CRP&#47;albumin ratio has been associated with worse prognosis in cancer<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> and can be used as a simple predictor of poor overall health&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">From a clinical standpoint&#44; assessment of the combination of increased CRP and decreased albumin levels makes sense&#44; seeing that these two molecules are involved in a range of complex and frequently interlinked processes ranging from inflammation to malnutrition&#44; and so in theory the ratio between them should have considerable potential as a prognostic marker&#46; However&#44; Rencuzogullari et al&#46; run a risk by attempting to associate this ratio with in-stent restenosis &#40;a serious albeit uncommon complication of percutaneous revascularization<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a>&#41; since&#44; like all indices of inflammatory markers used in cardiovascular assessment&#44; it is non-specific&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study is retrospective&#44; reviewing around six years of data from a single institution&#46; The population was of patients with ST-segment elevation myocardial infarction who underwent coronary angiography and percutaneous coronary intervention following standard indications&#46; Of these&#44; 448 who underwent repeat angiography due to recurrence of anginal symptoms were included in the study&#44; of whom 25&#37; &#40;110&#47;448&#41; presented in-stent restenosis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Unfortunately&#44; the study did not use high-sensitivity CRP assays&#44; which are firmly established in the literature as the gold standard for assessing vascular inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> The authors acknowledge that their use of an older test&#44; which is less sensitive and more likely to be influenced by rises in CRP due to non-vascular causes&#44; is a limitation to their study&#46; Their results also include a wide range of laboratory results&#44; from lipid profile to platelet count&#44; as well as platelet distribution width&#44; which is associated with myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> The study thus has the characteristics of a general review of in-stent restenosis&#44; even though drug-eluting stents&#44; which were designed to be less prone to restenosis&#44; were not used&#46; This limitation was also pointed out by the authors&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study concludes that the CRP&#47;albumin ratio is a better predictor than CRP or albumin individually&#44; at least in bare-metal stents&#46; Overall&#44; the work has merit&#44; especially in the emphasis it places on the use of inflammatory parameters in clinical practice&#46; However&#44; despite recent successes in proof-of-concept trials&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> and although inflammation has been the focus of much productive and challenging basic and clinical research over the last twenty years&#44; there is still some way to go before all the accumulated evidence can be brought to bear on daily clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">To conclude&#44; despite its limitations&#44; the paper under consideration adds another small piece to the puzzle in this challenging area in which research continues apace&#44; even though its conclusions need to be confirmed by further studies&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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Revista Portuguesa de Cardiologia (English edition)
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