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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Deaths from ischemic heart disease have decreased in recent years due to increased use of percutaneous coronary intervention &#40;PCI&#41;&#46; Primary PCI &#40;pPCI&#41; is generally the first line of treatment for patients with ST-segment elevation myocardial infarction &#40;STEMI&#41;&#44; and stenting is recommended over balloon angioplasty&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> However&#44; restenosis&#44; a gradual re-narrowing of the stented segment&#44; continues to be a clinical challenge&#46; Stent restenosis decreases the patient&#39;s quality of life and is associated with repeated coronary interventions as well as higher hospitalization rates and medical costs&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Stent restenosis is a complex and multifactorial process that begins with stent deployment in the coronary artery&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a> Inflammation plays a key role in arterial damage after stent placement&#44; accelerating macrophage accumulation and neovascularization&#46; The inflammation process also leads to neointimal tissue proliferation&#44; thrombus formation at the stent struts and activation of neutrophils&#44; fibrin and platelets&#44; all of which result in stent restenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;7</span></a> Studies on stent-induced inflammation have found a significant association between C-reactive protein &#40;CRP&#41; and stent restenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a> An acute phase protein that is released from the liver&#44; CRP is a useful marker for objectively stratifying an active inflammation process&#46; Similarly&#44; serum albumin is a negative acute phase protein in acute inflammation and has been shown to have an inverse relationship with stent restenosis&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The CRP&#47;albumin ratio has been identified as an inflammation-based prognostic marker and is considered to reflect the relationship between CRP and albumin levels in determining the prognosis of critical diseases and malignancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;12</span></a> The fact that the CRP&#47;albumin ratio is a good indicator of inflammatory status led us to investigate its relationship with stent restenosis&#46; In this study&#44; we aimed to assess whether the CRP&#47;albumin ratio and levels of CRP and albumin at the time of initial pPCI are associated with subsequent stent restenosis in STEMI patients who were treated with bare-metal stents &#40;BMS&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0020" class="elsevierStylePara elsevierViewall">Between January 2010 and June 2016&#44; 1844 STEMI patients were referred for coronary angiography and pPCI&#44; and these formed the basis of our study population&#46; Of these&#44; 191 were excluded from the study&#58; those referred for emergency coronary artery bypass graft surgery&#44; those treated noninvasively&#44; those under hemodialysis&#44; and those with malignancy&#44; fever or an autoimmune disorder&#46; Of the remaining 1653 patients&#44; 448 were referred for redo coronary angiography due to recurrence of anginal symptoms and were therefore included in this retrospective study &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The first STEMI was defined based on the following criteria&#58; a typical increase or decrease in cardiac biomarkers&#59; ongoing ischemic symptoms &#40;within 12 hours of presentation&#41;&#59; newly developed left bundle branch block pattern or new ST elevation in two or more contiguous leads&#44; with readings of at least 0&#46;2 mV in leads V1&#44; V2 and V3 or at least 0&#46;1 mV in the other leads&#59; or imaging evidence of a new loss of viable myocardium or new regional wall motion abnormality&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a> Stent restenosis was defined as the presence of clinical symptoms and&#47;or signs of ischemia and at least 50&#37; narrowing in lumen diameter at follow-up angiography&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The study protocol was reviewed and approved by the local ethics committee of Kafkas University and was conducted in accordance with the Declaration of Helsinki&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data collection</span><p id="par0030" class="elsevierStylePara elsevierViewall">All patients who were referred for coronary reintervention due to recurrence of ischemic symptoms were hospitalized&#46; To establish the effects of the first pPCI on subsequent stent restenosis&#44; patients&#8217; baseline clinical&#44; demographic&#44; biochemical and hematological characteristics at the time of the first pPCI were recorded&#46; Complete blood count and blood biochemical parameters were assessed in all patients on admission and prior to pPCI&#46; CRP and serum albumin levels were determined using an automatic biochemical analyzer &#40;Cobas 8000 c502&#44; Roche Diagnostics&#41;&#46; The CRP&#47;albumin ratio was calculated as the ratio of CRP to albumin multiplied by 10 for ease of interpretation&#46; The neutrophil&#47;lymphocyte ratio was calculated from the complete blood count obtained on admission&#46; Blood samples were retested for creatine kinase-myocardial band &#40;CK-MB&#41; every six hours until peak levels were identified&#46; The estimated glomerular filtration rate &#40;eGFR&#41; was determined using the Cockcroft-Gault formula from the blood samples obtained on admission&#46; Left ventricular ejection fraction &#40;LVEF&#41; was defined as the postprocedural ejection fraction and was assessed using a modified version of Simpson&#39;s method&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Angiographic analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">The standard Judkins percutaneous transfemoral technique was performed by experienced interventional cardiologists on all patients who underwent pPCI&#46; Coronary angiograms and pPCIs were recorded using digital media &#40;DICOM viewer&#44; MedCom GmbH&#44; Darmstadt&#44; Germany&#41;&#46; The digital angiography and PCI records of all patients who were admitted with STEMI and underwent BMS implantation &#40;the records of the first angiography&#41; were analyzed quantitatively in terms of lesion and intervention characteristics&#46; Coronary blood flow patterns before and after pPCI were assessed using Thrombolysis in Myocardial Infarction &#40;TIMI&#41; flow grade as defined previously&#44; and epicardial no-reflow was defined as TIMI flow grade &#60;3 at the target vessel lesion in the absence of spasm&#44; thrombus&#44; dissection and&#47;or significant residual stenosis&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Similarly&#44; thrombus burden was assessed according to the TIMI thrombus grading scale as defined by Gibson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> The sizes of the stents used in the interventions were confirmed from hospital records&#46; All patients had received 300 mg aspirin and a 600-mg loading dose of clopidogrel on a routine basis before the intervention and received unfractionated heparin during the intervention&#46; The decision whether to use tirofiban was left to the operator&#39;s discretion&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using IBM SPSS version 22&#46;0 &#40;IBM SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46; The normality of the data was determined using the Kolmogorov-Smirnov test&#46; With respect to data distribution and normality&#44; continuous variables were expressed as mean &#177; standard deviation or median &#91;interquartile range&#93; &#40;25th-75th percentiles&#41;&#44; and the t test or Mann-Whitney U-test was conducted to compare variables between two groups&#46; Continuous variables with and without normal distribution were compared between three groups using analysis of variance and the Kruskal-Wallis H-test&#44; respectively&#46; Categorical variables were presented as numbers &#40;percentages&#41; and compared using Fisher&#39;s exact test or the chi-square test&#46; Multivariate logistic regression analysis was performed to identify independent predictors of stent restenosis using variables that showed a statistically significant association with stent restenosis in univariate analysis&#46; Multicollinearity between the CRP&#47;albumin ratio and CRP and albumin levels was assessed by eigenvalues and condition indices&#46; Linearity was tested following the logarithmic transformation of each parameter&#46; A receiver operating characteristic &#40;ROC&#41; curve was used to derive the best cut-off value of the CRP&#47;albumin ratio for predicting stent restenosis using Youden&#39;s J statistic&#46; A p-value &#60;0&#46;05 was taken to indicate statistical significance&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study population consisted of 448 patients who underwent repeat coronary intervention &#40;mean age 56&#177;11 years&#59; 17&#46;8&#37; female&#41;&#46; The mean interval between coronary reintervention and the first STEMI was 21&#46;07&#177;3&#46;89 months&#46; Stent restenosis was observed in 24&#46;5&#37; &#40;n&#61;110&#41; of the study population who underwent a second coronary angiography&#46; The baseline clinical and angiographic characteristics of the total population and of patients with and without stent restenosis are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Patients with stent restenosis had a higher CRP&#47;albumin ratio&#44; more frequent involvement of the left anterior descending artery &#40;LAD&#41;&#44; greater platelet distribution width &#40;PDW&#41;&#44; higher CRP levels&#44; and lower levels of both high-density lipoprotein &#40;HDL&#41; cholesterol and serum albumin&#44; compared to those without stent restenosis&#46; Furthermore&#44; patients with stent restenosis had higher thrombus burden&#44; greater stent length and smaller angiographic reference lumen diameter&#44; and had more frequently received tirofiban infusion at the time of the first pPCI&#46; There was no difference between the two groups in terms of preprocedural TIMI flow &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Multivariate regression analysis was used to determine the independent predictors of stent restenosis using the parameters that were associated with stent restenosis in univariate analysis&#46; The CRP&#47;albumin ratio &#40;odds ratio &#91;OR&#93;&#58; 2&#46;289&#44; 95&#37; confidence interval &#91;CI&#93;&#58; 1&#46;056-4&#46;959&#59; p&#61;0&#46;036&#41;&#44; stent diameter &#40;per 1 mm&#44; OR&#58; 0&#46;370&#44; 95&#37; CI&#58; 0&#46;180-0&#46;760&#59; p&#61;0&#46;007&#41;&#44; PDW &#40;per 1 percent&#44; OR&#58; 1&#46;247&#44; 95&#37; CI&#58; 1&#46;023-1&#46;522&#59; p&#61;0&#46;029&#41;&#44; and HDL cholesterol &#40;OR&#58; 0&#46;973&#44; 95&#37; CI&#58; 0&#46;952-0&#46;994&#59; p&#61;0&#46;014&#41; were found to be independent predictors of stent restenosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The variables included in the multivariate analysis were infarct-related artery&#44; high-grade thrombus burden&#44; stent length&#44; stent diameter&#44; PDW&#44; HDL cholesterol and CRP&#47;albumin ratio&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Because no specific cut-off was identified for the CRP&#47;albumin ratio&#44; subjects who underwent repeat coronary angiography were stratified into three groups according to CRP&#47;albumin ratio by equalizing the number of patients&#58; tertile 1 &#40;&#60;0&#46;170&#44; n&#61;149&#41;&#44; tertile 2 &#40;0&#46;170-0&#46;363&#44; n&#61;150&#41; and tertile 3 &#40;&#62;0&#46;363&#44; n&#61;149&#41;&#46; There were significant differences between these tertiles&#46; Mean CRP level&#44; age&#44; frequency of hypertension&#44; total ischemia time&#44; peak CK-MB&#44; incidence of proximal coronary lesion involvement&#44; LAD involvement as the infarct-related artery&#44; and presence of no-reflow increased progressively from tertile 1 to tertile 3&#44; while LVEF and albumin levels decreased progressively &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; It was also observed that stent restenosis increased progressively with the tertiles&#8217; increasing CRP&#47;albumin ratio &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In ROC curve analysis&#44; the area under the curve &#40;AUC&#41; of the CRP&#47;albumin ratio was 0&#46;601 &#40;95&#37; CI&#58; 0&#46;540-0&#46;661&#59; p&#60;0&#46;001&#41;&#46; The cut-off value for the CRP&#47;albumin ratio that indicated stent restenosis was 0&#46;167 &#40;with 80&#46;9&#37; sensitivity and 36&#46;1&#37; specificity&#41;&#46; ROC curve comparisons were used to determine which variables best predicted stent restenosis&#46; The CRP&#47;albumin ratio was a better predictor than both serum albumin &#40;AUC&#58; 0&#46;577&#44; 95&#37; CI&#58; 0&#46;516-0&#46;638&#41; and CRP &#40;AUC&#58; 0&#46;582&#44; 95&#37; CI&#58; 0&#46;524-0&#46;641&#41; &#40;p&#61;0&#46;050 and p&#61;0&#46;008&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#44; but there was no significant difference between CRP&#47;albumin ratio and PDW &#40;AUC&#58; 0&#46;604&#44; 95&#37; CI 0&#46;541-0&#46;667&#41; and HDL cholesterol &#40;AUC&#58; 0&#46;602&#44; 95&#37; CI&#58; 0&#46;538-0&#46;665&#41; &#40;p&#61;0&#46;942 and p&#61;0&#46;961&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Our study demonstrated that the CRP&#47;albumin ratio was not only associated with&#44; but was also an independent predictor of stent restenosis in STEMI patients undergoing pPCI&#46; The CRP&#47;albumin ratio was better than both CRP and serum albumin levels&#44; individually&#44; in predicting stent restenosis&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">pPCI is the standard treatment for patients with STEMI&#46; Compared with balloon angioplasty alone&#44; stenting with a BMS is associated with a lower risk of reinfarction and target vessel revascularization&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> However&#44; with a restenosis rate of 12&#46;7&#37; with drug-eluting stents &#40;DES&#41; and 20&#46;1&#37; with BMS&#44; stent restenosis remains a major concern for the management of STEMI in patients treated with pPCI&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> In our study&#44; stent restenosis was observed in 24&#46;5&#37; of patients who were referred for repeat coronary angiography&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The etiology of stent restenosis is complex and multifactorial&#46; Several risk factors have been identified&#44; including angiographic&#44; clinical and technical factors&#46; Consistent with the results of previous studies&#44; patients with stent restenosis in our study had longer stents and smaller stent lumen diameter&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> higher CRP levels&#44;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a> and lower levels of HDL cholesterol<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> and serum albumin&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Additionally&#44; the CRP&#47;albumin ratio was significantly higher and PDW was greater in patients with restenosis than in those without&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Inflammation plays a central role in stent restenosis&#46; It has been previously established in animal models that there is a significant correlation between the severity of arterial inflammation and neointimal hyperplasia following balloon angioplasty and stenting&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">19&#44;20</span></a> The local inflammatory reaction induced by the trauma of stenting leads to the release of cytokines and growth factors from macrophages and smooth muscle cells&#44; resulting in a proliferative response&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> More importantly&#44; higher baseline levels of acute-phase proteins indicate the hyper-responsiveness of inflammatory cells to any inflammatory stimuli&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> Hence&#44; higher systemic CRP levels or lower serum albumin levels identify patients with an enhanced inflammatory response in the vessel wall to the inflammatory stimulus of stenting&#46; In our study&#44; baseline CRP levels were higher and serum albumin levels were significantly lower in patients with stent restenosis&#46; These findings strongly suggest that baseline inflammatory status is a determining factor in the development of stent restenosis&#44; in addition to the classical etiological factors&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We found that the baseline inflammatory response was exacerbated in patients with restenosis&#46; We also observed that patients&#8217; baseline inflammatory status was related to factors associated with a larger infarct area&#44; including LAD involvement as the culprit lesion&#44; no-reflow&#44; prolonged total ischemia time and elevated peak CK-MB levels&#46; Acute myocardial infarction triggers an inflammatory response that lasts for weeks and months&#44; and this mid-term inflammatory response seems to be more severe in patients with large infarcts and high baseline inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> However&#44; an increased baseline inflammatory response in patients with restenosis cannot be explained by infarct size alone&#46; Our patients with increased CRP&#47;albumin ratios were older and more frequently had a history of hypertension in addition to reduced eGFR and LVEF&#46; Chronic renal insufficiency has been associated with background inflammation&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a> and there is a consistent correlation between heart failure &#40;lower LVEF&#41; and inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> In addition&#44; aging is accompanied by two- to four-fold increases in the plasma&#47;serum levels of inflammatory mediators such as cytokines and acute phase proteins&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> Hypertension is also clearly associated with chronic mild inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> Although not all these factors were found to be individually associated with stent restenosis in our study&#44; their cumulative effect might have contributed to an association between the CRP&#47;albumin ratio and restenosis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The various acute phase reactants may not all respond to inflammatory events to the same degree&#46; Merging albumin and CRP into a single index as an inflammation-based prognostic score provides stability between fluctuating CRP and albumin levels in diseases where inflammation plays an important role&#46; The CRP&#47;albumin ratio has been used as a parameter of inflammatory status in many studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;12&#44;28&#44;29</span></a> Consistent with previous findings&#44; the present study showed that the CRP&#47;albumin ratio was a better predictor of stent restenosis than either CRP or albumin&#44; individually&#44; in ROC curve analysis&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Interestingly&#44; the present study found PDW to be an independent predictor of stent restenosis&#46; PDW indicates variability in platelet size&#44; which is directly related to platelet density and reactivity in circulating platelets&#46; Changes in these variables play an important role in the development of acute coronary syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> Recently&#44; it has been shown that PDW is associated with acute stent thrombosis<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> and is an independent predictor of no-reflow and in-hospital major cardiac adverse events<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> in STEMI patients&#46; In this study&#44; for the first time&#44; we demonstrated that PDW is an independent predictor of stent restenosis&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In addition to inflammation-induced neointimal hyperplasia and vascular remodeling&#44; oxidative stress and increased vascular levels of reactive oxygen species are also thought to be involved in the pathophysiology of stent restenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">33&#44;34</span></a> HDL cholesterol molecules reduce macrophage accumulation&#44; promote removal of oxidized cholesterol from the arterial wall&#44; and can inhibit monocyte activation&#44; adhesiveness and inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">35&#8211;37</span></a> Previous studies have shown that lower HDL levels are an independent risk factor for stent restenosis in different patient groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">38&#8211;40</span></a> Our study also showed that HDL cholesterol is an independent predictor of stent restenosis&#46; A comparison of the ROC curves showed that CRP&#47;albumin ratio&#44; PDW and HDL cholesterol levels were not inferior to each other in predicting stent restenosis&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limitations</span><p id="par0110" class="elsevierStylePara elsevierViewall">The present study has several limitations&#46; First&#44; although the data were acquired prospectively&#44; the study had a retrospective design and was based on a registry analysis&#46; Second&#44; this study provided information about stent restenosis in STEMI patients treated with BMS&#59; it did not include information on patients treated with DES&#44; which currently are widely used&#46; Third&#44; high-sensitivity CRP&#44; which has proven efficacy in demonstrating endovascular inflammation&#44; could not be used in our study&#44; due to the lack of this information in our subjects&#8217; patient records&#46; Finally&#44; the prognostic value of the CRP&#47;albumin ratio could not be assessed in the present study&#46; Stent restenosis and patient prognosis may not necessarily correlate&#59; therefore&#44; the prognostic value of the CRP&#47;albumin ratio in the development of stent restenosis should be verified by further research&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">This study suggests that baseline inflammatory status appears to be a significant factor in subsequent stent restenosis in STEMI patients&#46; Based on the evidence that the CRP&#47;albumin ratio is a better predictor than CRP or albumin&#44; individually&#44; assessment of a patient&#39;s preprocedural CRP&#47;albumin ratio could be beneficial&#46; In STEMI patients&#44; a high CRP&#47;albumin ratio on admission may be an early&#44; mid- and long-term marker of inflammation that could lead to stent restenosis&#46; Although this study only analyzed restenosis with BMS&#44; which does not correspond to the majority of stents currently used in developed countries&#44; the mechanisms underlying stent restenosis may be common to other types of stents&#44; and this research may be a bridge to DES studies&#46; Additionally&#44; for the first time&#44; PDW has been found to be an independent predictor of stent restenosis&#46; Therefore&#44; PDW may be another easily accessible marker for the risk assessment of stent restenosis&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research&#44; authorship&#44; and&#47;or publication of this article&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare</p></span></span>"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-12-15"
    "fechaAceptado" => "2018-08-24"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1174818"
          "palabras" => array:4 [
            0 => "Stent restenosis"
            1 => "C-reactive protein&#47;albumin ratio"
            2 => "ST-segment elevation myocardial infarction"
            3 => "Inflammation"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras chave"
          "identificador" => "xpalclavsec1174819"
          "palabras" => array:4 [
            0 => "Reestenose de <span class="elsevierStyleItalic">stent</span>"
            1 => "Prote&#237;na C reativa&#47;albumina"
            2 => "Enfarte do mioc&#225;rdio com eleva&#231;&#227;o do segmento ST"
            3 => "Inflama&#231;&#227;o"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Stent restenosis remains a clinical challenge for patients with ischemic heart disease&#44; since it is associated with repeated coronary interventions as well as higher hospitalization rates and medical costs&#46; Inflammation plays a significant role&#46; Although an association between stent restenosis&#44; increased C-reactive protein &#40;CRP&#41; and decreased albumin levels has been previously reported&#44; no studies have investigated the ability of the CRP&#47;albumin ratio to predict stent restenosis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This retrospective study included 448 patients who had previously undergone primary percutaneous coronary intervention and who were referred for subsequent reintervention due to recurrence of anginal symptoms&#46; The study population was divided into two groups based on whether the patient had developed stent restenosis&#46; They were then stratified into three groups according to their CRP&#47;albumin ratio&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Out of 448 patients&#44; stent restenosis was observed in 24&#46;5&#37; &#40;n&#61;110&#41;&#44; as determined by coronary angiography&#46; Patients with stent restenosis had a higher CRP&#47;albumin ratio&#44; greater platelet distribution width &#40;PDW&#41;&#44; higher CRP levels&#44; and lower levels of both high-density lipoprotein &#40;HDL&#41; cholesterol and serum albumin&#46; The CRP&#47;albumin ratio &#40;OR&#58; 2&#46;289&#44; 95&#37; CI&#58; 1&#46;056-4&#46;959&#59; p&#61;0&#46;036&#41;&#44; stent diameter&#44; PDW and HDL cholesterol levels were found to be independent predictors of stent restenosis&#46; A ROC curve comparison demonstrated that the CRP&#47;albumin ratio was a better predictor of restenosis than either albumin and CRP individually&#44; but it was not better than PDW and HDL cholesterol&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As a novel inflammation-based risk score&#44; the CRP&#47;albumin ratio may be an easily accessible marker for assessment of stent restenosis risk&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A reestenose de <span class="elsevierStyleItalic">stent</span> permanece como um desafio cl&#237;nico em doentes com cardiopatia isqu&#233;mica&#46; A reestenose de <span class="elsevierStyleItalic">stent</span> est&#225; associada a interven&#231;&#245;es coron&#225;rias recorrentes bem como a aumento de internamentos e de custos m&#233;dicos&#46; A inflama&#231;&#227;o tem um papel significativo&#46; Embora a associa&#231;&#227;o entre reestenose de <span class="elsevierStyleItalic">stent</span> e o aumento dos n&#237;veis de prote&#237;na C-reativa &#40;PCR&#41; e a diminui&#231;&#227;o dos n&#237;veis de albumina tenham sido previamente registados&#44; nenhum estudo pesquisou a possibilidade da PCR&#47;albumina prever um diagn&#243;stico de reestenose de <span class="elsevierStyleItalic">stent</span>&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este estudo retrospetivo incluiu 448 doentes que tinham sido previamente submetidos a interven&#231;&#227;o coron&#225;ria percut&#226;nea prim&#225;ria e que foram referidos para reinterven&#231;&#227;o posterior devido a ressurgimento dos sintomas de angina&#46; A popula&#231;&#227;o do estudo foi dividida em dois grupos com base no facto do doente ter desenvolvido reestenose de <span class="elsevierStyleItalic">stent</span>&#46; Posteriormente&#44; foram estratificados em tr&#234;s grupos de acordo com as rela&#231;&#245;es PCR&#47;albumina&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De um grupo de 448 doentes&#44; a reestenose de <span class="elsevierStyleItalic">stent</span> foi observada em 24&#44;5&#37; &#40;n &#61; 110&#41;&#44; conforme determinado por avalia&#231;&#227;o atrav&#233;s de angiografia coron&#225;ria&#46; Os doentes com reestenose de <span class="elsevierStyleItalic">stent</span> apresentaram uma rela&#231;&#227;o PCR&#47;albumina mais elevada&#44; varia&#231;&#227;o maior do di&#226;metro das plaquetas &#40;DP&#41;&#44; n&#237;veis mais elevados de PCR e n&#237;veis mais baixos de colesterol de lipoprote&#237;nas de alta densidade &#40;HDL&#41; e de albumina s&#233;rica&#46; Os n&#237;veis da rela&#231;&#227;o PCR&#47;albumina &#40;OR&#58; 2&#44;289&#44; IC 95&#37;&#58;1&#44;056 &#8211; 4&#44;959&#59; p &#61; 0&#44;036&#41;&#44; o di&#226;metro do <span class="elsevierStyleItalic">stent</span>&#44; a varia&#231;&#227;o maior do DP e o colesterol HDL foram considerados fatores preditores independentes da restenose de <span class="elsevierStyleItalic">stent</span>&#46; A compara&#231;&#227;o das curvas ROC demonstrou que a rela&#231;&#227;o PCR&#47;albumina constituiu um fator preditor melhor do que a albumina e a PCR&#44; isoladamente&#44; n&#227;o sendo&#44; no entanto&#44; melhor do que o DP e o colesterol HDL&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Como novo <span class="elsevierStyleItalic">score</span> de risco baseado em inflama&#231;&#227;o&#44; a rela&#231;&#227;o PCR&#47;albumina pode ser um marcador facilmente acess&#237;vel para a avalia&#231;&#227;o do risco de reestenose de <span class="elsevierStyleItalic">stent</span>&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
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        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of enrollment and follow-up of study patients&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curves to detect the best variable for predicting stent restenosis&#46; AUC&#58; area under the curve&#59; CRP&#58; C-reactive protein&#46;</p>"
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      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curves comparing independent predictors of laboratory parameters to detect the best predictor of stent restenosis&#46; AUC&#58; area under the curve&#59; CRP&#58; C-reactive protein&#59; HDL-C&#58; high-density lipoprotein cholesterol&#59; PDW&#58; platelet distribution width&#46;</p>"
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      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CK-MB&#58; creatine kinase-myocardial band&#59; CRP&#58; C-reactive protein&#59; CX&#58; circumflex artery&#59; eGFR&#58; estimated glomerular filtration rate&#59; HDL-C&#58; high-density lipoprotein cholesterol&#59; IQR&#58; interquartile range &#40;25th-75th percentiles&#41;&#59; IRA&#58; infarct-related artery&#59; LAD&#58; left anterior descending artery&#59; LDL-C&#58; low-density lipoprotein cholesterol&#59; LVEF&#58; left ventricular ejection fraction&#59; PDW&#58; platelet distribution width&#59; RCA&#58; right coronary artery&#59; SR&#58; stent restenosis&#59; STEMI&#58; ST-segment elevation myocardial infarction&#59; WBC&#58; white blood cell&#46;</p>"
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                  \t\t\t\t">56&#177;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Total ischemia time&#44; min&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Proximal&#47;ostial lesion as IRA&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">High-grade thrombus burden&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lymphocyte count&#44; &#47;1000&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Triglycerides&#44; mg&#47;dl&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Time from first STEMI to reintervention &#40;months&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Platelet count&#44; 10 000&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Neutrophil count&#44; &#47;1000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lymphocyte count&#44; &#47;1000&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Triglycerides&#44; mg&#47;dl&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Glucose on admission&#44; mg&#47;dl&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">eGFR&#44; ml&#47;min&#47;1&#46;73 m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; clinical&#44; laboratory and coronary angiographic characteristics of the study population stratified according to C-reactive protein&#47;albumin ratio&#46;</p>"
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Original Article
Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction
Ibrahim Rencuzogullaria,
Autor para correspondência
rencuzog@gmail.com

Corresponding author.
, Yavuz Karabağa, Metin Çağdaşa, Süleyman Karakoyuna, Sabri Seyisb, Mustafa Ozan Gürsoyc, Mahmut Yesind, İnanç Artaça, Doğan İlişa, İbrahim Halil Tanboğae
a M.D. Kafkas University Medical Faculty, Department of Cardiology, Kars, Turkey
b M.D. Istinye University Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
c M.D. Gaziemir State Hospital, Department of Cardiology, İzmir, Turkey
d M.D. Kars Harakani State Hospital, Department of Cardiology, Kars, Turkey
e M.D. Ataturk University Medical Faculty, Department of Cardiology, Erzurum, Turkey
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accelerating macrophage accumulation and neovascularization&#46; The inflammation process also leads to neointimal tissue proliferation&#44; thrombus formation at the stent struts and activation of neutrophils&#44; fibrin and platelets&#44; all of which result in stent restenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6&#44;7</span></a> Studies on stent-induced inflammation have found a significant association between C-reactive protein &#40;CRP&#41; and stent restenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a> An acute phase protein that is released from the liver&#44; CRP is a useful marker for objectively stratifying an active inflammation process&#46; Similarly&#44; serum albumin is a negative acute phase protein in acute inflammation and has been shown to have an inverse relationship with stent restenosis&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The CRP&#47;albumin ratio has been identified as an inflammation-based prognostic marker and is considered to reflect the relationship between CRP and albumin levels in determining the prognosis of critical diseases and malignancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;12</span></a> The fact that the CRP&#47;albumin ratio is a good indicator of inflammatory status led us to investigate its relationship with stent restenosis&#46; In this study&#44; we aimed to assess whether the CRP&#47;albumin ratio and levels of CRP and albumin at the time of initial pPCI are associated with subsequent stent restenosis in STEMI patients who were treated with bare-metal stents &#40;BMS&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0020" class="elsevierStylePara elsevierViewall">Between January 2010 and June 2016&#44; 1844 STEMI patients were referred for coronary angiography and pPCI&#44; and these formed the basis of our study population&#46; Of these&#44; 191 were excluded from the study&#58; those referred for emergency coronary artery bypass graft surgery&#44; those treated noninvasively&#44; those under hemodialysis&#44; and those with malignancy&#44; fever or an autoimmune disorder&#46; Of the remaining 1653 patients&#44; 448 were referred for redo coronary angiography due to recurrence of anginal symptoms and were therefore included in this retrospective study &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The first STEMI was defined based on the following criteria&#58; a typical increase or decrease in cardiac biomarkers&#59; ongoing ischemic symptoms &#40;within 12 hours of presentation&#41;&#59; newly developed left bundle branch block pattern or new ST elevation in two or more contiguous leads&#44; with readings of at least 0&#46;2 mV in leads V1&#44; V2 and V3 or at least 0&#46;1 mV in the other leads&#59; or imaging evidence of a new loss of viable myocardium or new regional wall motion abnormality&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a> Stent restenosis was defined as the presence of clinical symptoms and&#47;or signs of ischemia and at least 50&#37; narrowing in lumen diameter at follow-up angiography&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The study protocol was reviewed and approved by the local ethics committee of Kafkas University and was conducted in accordance with the Declaration of Helsinki&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data collection</span><p id="par0030" class="elsevierStylePara elsevierViewall">All patients who were referred for coronary reintervention due to recurrence of ischemic symptoms were hospitalized&#46; To establish the effects of the first pPCI on subsequent stent restenosis&#44; patients&#8217; baseline clinical&#44; demographic&#44; biochemical and hematological characteristics at the time of the first pPCI were recorded&#46; Complete blood count and blood biochemical parameters were assessed in all patients on admission and prior to pPCI&#46; CRP and serum albumin levels were determined using an automatic biochemical analyzer &#40;Cobas 8000 c502&#44; Roche Diagnostics&#41;&#46; The CRP&#47;albumin ratio was calculated as the ratio of CRP to albumin multiplied by 10 for ease of interpretation&#46; The neutrophil&#47;lymphocyte ratio was calculated from the complete blood count obtained on admission&#46; Blood samples were retested for creatine kinase-myocardial band &#40;CK-MB&#41; every six hours until peak levels were identified&#46; The estimated glomerular filtration rate &#40;eGFR&#41; was determined using the Cockcroft-Gault formula from the blood samples obtained on admission&#46; Left ventricular ejection fraction &#40;LVEF&#41; was defined as the postprocedural ejection fraction and was assessed using a modified version of Simpson&#39;s method&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Angiographic analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">The standard Judkins percutaneous transfemoral technique was performed by experienced interventional cardiologists on all patients who underwent pPCI&#46; Coronary angiograms and pPCIs were recorded using digital media &#40;DICOM viewer&#44; MedCom GmbH&#44; Darmstadt&#44; Germany&#41;&#46; The digital angiography and PCI records of all patients who were admitted with STEMI and underwent BMS implantation &#40;the records of the first angiography&#41; were analyzed quantitatively in terms of lesion and intervention characteristics&#46; Coronary blood flow patterns before and after pPCI were assessed using Thrombolysis in Myocardial Infarction &#40;TIMI&#41; flow grade as defined previously&#44; and epicardial no-reflow was defined as TIMI flow grade &#60;3 at the target vessel lesion in the absence of spasm&#44; thrombus&#44; dissection and&#47;or significant residual stenosis&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Similarly&#44; thrombus burden was assessed according to the TIMI thrombus grading scale as defined by Gibson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> The sizes of the stents used in the interventions were confirmed from hospital records&#46; All patients had received 300 mg aspirin and a 600-mg loading dose of clopidogrel on a routine basis before the intervention and received unfractionated heparin during the intervention&#46; The decision whether to use tirofiban was left to the operator&#39;s discretion&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The statistical analysis was performed using IBM SPSS version 22&#46;0 &#40;IBM SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46; The normality of the data was determined using the Kolmogorov-Smirnov test&#46; With respect to data distribution and normality&#44; continuous variables were expressed as mean &#177; standard deviation or median &#91;interquartile range&#93; &#40;25th-75th percentiles&#41;&#44; and the t test or Mann-Whitney U-test was conducted to compare variables between two groups&#46; Continuous variables with and without normal distribution were compared between three groups using analysis of variance and the Kruskal-Wallis H-test&#44; respectively&#46; Categorical variables were presented as numbers &#40;percentages&#41; and compared using Fisher&#39;s exact test or the chi-square test&#46; Multivariate logistic regression analysis was performed to identify independent predictors of stent restenosis using variables that showed a statistically significant association with stent restenosis in univariate analysis&#46; Multicollinearity between the CRP&#47;albumin ratio and CRP and albumin levels was assessed by eigenvalues and condition indices&#46; Linearity was tested following the logarithmic transformation of each parameter&#46; A receiver operating characteristic &#40;ROC&#41; curve was used to derive the best cut-off value of the CRP&#47;albumin ratio for predicting stent restenosis using Youden&#39;s J statistic&#46; A p-value &#60;0&#46;05 was taken to indicate statistical significance&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study population consisted of 448 patients who underwent repeat coronary intervention &#40;mean age 56&#177;11 years&#59; 17&#46;8&#37; female&#41;&#46; The mean interval between coronary reintervention and the first STEMI was 21&#46;07&#177;3&#46;89 months&#46; Stent restenosis was observed in 24&#46;5&#37; &#40;n&#61;110&#41; of the study population who underwent a second coronary angiography&#46; The baseline clinical and angiographic characteristics of the total population and of patients with and without stent restenosis are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Patients with stent restenosis had a higher CRP&#47;albumin ratio&#44; more frequent involvement of the left anterior descending artery &#40;LAD&#41;&#44; greater platelet distribution width &#40;PDW&#41;&#44; higher CRP levels&#44; and lower levels of both high-density lipoprotein &#40;HDL&#41; cholesterol and serum albumin&#44; compared to those without stent restenosis&#46; Furthermore&#44; patients with stent restenosis had higher thrombus burden&#44; greater stent length and smaller angiographic reference lumen diameter&#44; and had more frequently received tirofiban infusion at the time of the first pPCI&#46; There was no difference between the two groups in terms of preprocedural TIMI flow &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Multivariate regression analysis was used to determine the independent predictors of stent restenosis using the parameters that were associated with stent restenosis in univariate analysis&#46; The CRP&#47;albumin ratio &#40;odds ratio &#91;OR&#93;&#58; 2&#46;289&#44; 95&#37; confidence interval &#91;CI&#93;&#58; 1&#46;056-4&#46;959&#59; p&#61;0&#46;036&#41;&#44; stent diameter &#40;per 1 mm&#44; OR&#58; 0&#46;370&#44; 95&#37; CI&#58; 0&#46;180-0&#46;760&#59; p&#61;0&#46;007&#41;&#44; PDW &#40;per 1 percent&#44; OR&#58; 1&#46;247&#44; 95&#37; CI&#58; 1&#46;023-1&#46;522&#59; p&#61;0&#46;029&#41;&#44; and HDL cholesterol &#40;OR&#58; 0&#46;973&#44; 95&#37; CI&#58; 0&#46;952-0&#46;994&#59; p&#61;0&#46;014&#41; were found to be independent predictors of stent restenosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The variables included in the multivariate analysis were infarct-related artery&#44; high-grade thrombus burden&#44; stent length&#44; stent diameter&#44; PDW&#44; HDL cholesterol and CRP&#47;albumin ratio&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Because no specific cut-off was identified for the CRP&#47;albumin ratio&#44; subjects who underwent repeat coronary angiography were stratified into three groups according to CRP&#47;albumin ratio by equalizing the number of patients&#58; tertile 1 &#40;&#60;0&#46;170&#44; n&#61;149&#41;&#44; tertile 2 &#40;0&#46;170-0&#46;363&#44; n&#61;150&#41; and tertile 3 &#40;&#62;0&#46;363&#44; n&#61;149&#41;&#46; There were significant differences between these tertiles&#46; Mean CRP level&#44; age&#44; frequency of hypertension&#44; total ischemia time&#44; peak CK-MB&#44; incidence of proximal coronary lesion involvement&#44; LAD involvement as the infarct-related artery&#44; and presence of no-reflow increased progressively from tertile 1 to tertile 3&#44; while LVEF and albumin levels decreased progressively &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; It was also observed that stent restenosis increased progressively with the tertiles&#8217; increasing CRP&#47;albumin ratio &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In ROC curve analysis&#44; the area under the curve &#40;AUC&#41; of the CRP&#47;albumin ratio was 0&#46;601 &#40;95&#37; CI&#58; 0&#46;540-0&#46;661&#59; p&#60;0&#46;001&#41;&#46; The cut-off value for the CRP&#47;albumin ratio that indicated stent restenosis was 0&#46;167 &#40;with 80&#46;9&#37; sensitivity and 36&#46;1&#37; specificity&#41;&#46; ROC curve comparisons were used to determine which variables best predicted stent restenosis&#46; The CRP&#47;albumin ratio was a better predictor than both serum albumin &#40;AUC&#58; 0&#46;577&#44; 95&#37; CI&#58; 0&#46;516-0&#46;638&#41; and CRP &#40;AUC&#58; 0&#46;582&#44; 95&#37; CI&#58; 0&#46;524-0&#46;641&#41; &#40;p&#61;0&#46;050 and p&#61;0&#46;008&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#44; but there was no significant difference between CRP&#47;albumin ratio and PDW &#40;AUC&#58; 0&#46;604&#44; 95&#37; CI 0&#46;541-0&#46;667&#41; and HDL cholesterol &#40;AUC&#58; 0&#46;602&#44; 95&#37; CI&#58; 0&#46;538-0&#46;665&#41; &#40;p&#61;0&#46;942 and p&#61;0&#46;961&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Our study demonstrated that the CRP&#47;albumin ratio was not only associated with&#44; but was also an independent predictor of stent restenosis in STEMI patients undergoing pPCI&#46; The CRP&#47;albumin ratio was better than both CRP and serum albumin levels&#44; individually&#44; in predicting stent restenosis&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">pPCI is the standard treatment for patients with STEMI&#46; Compared with balloon angioplasty alone&#44; stenting with a BMS is associated with a lower risk of reinfarction and target vessel revascularization&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> However&#44; with a restenosis rate of 12&#46;7&#37; with drug-eluting stents &#40;DES&#41; and 20&#46;1&#37; with BMS&#44; stent restenosis remains a major concern for the management of STEMI in patients treated with pPCI&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> In our study&#44; stent restenosis was observed in 24&#46;5&#37; of patients who were referred for repeat coronary angiography&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The etiology of stent restenosis is complex and multifactorial&#46; Several risk factors have been identified&#44; including angiographic&#44; clinical and technical factors&#46; Consistent with the results of previous studies&#44; patients with stent restenosis in our study had longer stents and smaller stent lumen diameter&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> higher CRP levels&#44;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;8&#44;9</span></a> and lower levels of HDL cholesterol<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> and serum albumin&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a> Additionally&#44; the CRP&#47;albumin ratio was significantly higher and PDW was greater in patients with restenosis than in those without&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Inflammation plays a central role in stent restenosis&#46; It has been previously established in animal models that there is a significant correlation between the severity of arterial inflammation and neointimal hyperplasia following balloon angioplasty and stenting&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">19&#44;20</span></a> The local inflammatory reaction induced by the trauma of stenting leads to the release of cytokines and growth factors from macrophages and smooth muscle cells&#44; resulting in a proliferative response&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> More importantly&#44; higher baseline levels of acute-phase proteins indicate the hyper-responsiveness of inflammatory cells to any inflammatory stimuli&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> Hence&#44; higher systemic CRP levels or lower serum albumin levels identify patients with an enhanced inflammatory response in the vessel wall to the inflammatory stimulus of stenting&#46; In our study&#44; baseline CRP levels were higher and serum albumin levels were significantly lower in patients with stent restenosis&#46; These findings strongly suggest that baseline inflammatory status is a determining factor in the development of stent restenosis&#44; in addition to the classical etiological factors&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We found that the baseline inflammatory response was exacerbated in patients with restenosis&#46; We also observed that patients&#8217; baseline inflammatory status was related to factors associated with a larger infarct area&#44; including LAD involvement as the culprit lesion&#44; no-reflow&#44; prolonged total ischemia time and elevated peak CK-MB levels&#46; Acute myocardial infarction triggers an inflammatory response that lasts for weeks and months&#44; and this mid-term inflammatory response seems to be more severe in patients with large infarcts and high baseline inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> However&#44; an increased baseline inflammatory response in patients with restenosis cannot be explained by infarct size alone&#46; Our patients with increased CRP&#47;albumin ratios were older and more frequently had a history of hypertension in addition to reduced eGFR and LVEF&#46; Chronic renal insufficiency has been associated with background inflammation&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a> and there is a consistent correlation between heart failure &#40;lower LVEF&#41; and inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> In addition&#44; aging is accompanied by two- to four-fold increases in the plasma&#47;serum levels of inflammatory mediators such as cytokines and acute phase proteins&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> Hypertension is also clearly associated with chronic mild inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> Although not all these factors were found to be individually associated with stent restenosis in our study&#44; their cumulative effect might have contributed to an association between the CRP&#47;albumin ratio and restenosis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The various acute phase reactants may not all respond to inflammatory events to the same degree&#46; Merging albumin and CRP into a single index as an inflammation-based prognostic score provides stability between fluctuating CRP and albumin levels in diseases where inflammation plays an important role&#46; The CRP&#47;albumin ratio has been used as a parameter of inflammatory status in many studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;12&#44;28&#44;29</span></a> Consistent with previous findings&#44; the present study showed that the CRP&#47;albumin ratio was a better predictor of stent restenosis than either CRP or albumin&#44; individually&#44; in ROC curve analysis&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Interestingly&#44; the present study found PDW to be an independent predictor of stent restenosis&#46; PDW indicates variability in platelet size&#44; which is directly related to platelet density and reactivity in circulating platelets&#46; Changes in these variables play an important role in the development of acute coronary syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a> Recently&#44; it has been shown that PDW is associated with acute stent thrombosis<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a> and is an independent predictor of no-reflow and in-hospital major cardiac adverse events<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> in STEMI patients&#46; In this study&#44; for the first time&#44; we demonstrated that PDW is an independent predictor of stent restenosis&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In addition to inflammation-induced neointimal hyperplasia and vascular remodeling&#44; oxidative stress and increased vascular levels of reactive oxygen species are also thought to be involved in the pathophysiology of stent restenosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">33&#44;34</span></a> HDL cholesterol molecules reduce macrophage accumulation&#44; promote removal of oxidized cholesterol from the arterial wall&#44; and can inhibit monocyte activation&#44; adhesiveness and inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">35&#8211;37</span></a> Previous studies have shown that lower HDL levels are an independent risk factor for stent restenosis in different patient groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">38&#8211;40</span></a> Our study also showed that HDL cholesterol is an independent predictor of stent restenosis&#46; A comparison of the ROC curves showed that CRP&#47;albumin ratio&#44; PDW and HDL cholesterol levels were not inferior to each other in predicting stent restenosis&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Limitations</span><p id="par0110" class="elsevierStylePara elsevierViewall">The present study has several limitations&#46; First&#44; although the data were acquired prospectively&#44; the study had a retrospective design and was based on a registry analysis&#46; Second&#44; this study provided information about stent restenosis in STEMI patients treated with BMS&#59; it did not include information on patients treated with DES&#44; which currently are widely used&#46; Third&#44; high-sensitivity CRP&#44; which has proven efficacy in demonstrating endovascular inflammation&#44; could not be used in our study&#44; due to the lack of this information in our subjects&#8217; patient records&#46; Finally&#44; the prognostic value of the CRP&#47;albumin ratio could not be assessed in the present study&#46; Stent restenosis and patient prognosis may not necessarily correlate&#59; therefore&#44; the prognostic value of the CRP&#47;albumin ratio in the development of stent restenosis should be verified by further research&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">This study suggests that baseline inflammatory status appears to be a significant factor in subsequent stent restenosis in STEMI patients&#46; Based on the evidence that the CRP&#47;albumin ratio is a better predictor than CRP or albumin&#44; individually&#44; assessment of a patient&#39;s preprocedural CRP&#47;albumin ratio could be beneficial&#46; In STEMI patients&#44; a high CRP&#47;albumin ratio on admission may be an early&#44; mid- and long-term marker of inflammation that could lead to stent restenosis&#46; Although this study only analyzed restenosis with BMS&#44; which does not correspond to the majority of stents currently used in developed countries&#44; the mechanisms underlying stent restenosis may be common to other types of stents&#44; and this research may be a bridge to DES studies&#46; Additionally&#44; for the first time&#44; PDW has been found to be an independent predictor of stent restenosis&#46; Therefore&#44; PDW may be another easily accessible marker for the risk assessment of stent restenosis&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research&#44; authorship&#44; and&#47;or publication of this article&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Stent restenosis remains a clinical challenge for patients with ischemic heart disease&#44; since it is associated with repeated coronary interventions as well as higher hospitalization rates and medical costs&#46; Inflammation plays a significant role&#46; Although an association between stent restenosis&#44; increased C-reactive protein &#40;CRP&#41; and decreased albumin levels has been previously reported&#44; no studies have investigated the ability of the CRP&#47;albumin ratio to predict stent restenosis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This retrospective study included 448 patients who had previously undergone primary percutaneous coronary intervention and who were referred for subsequent reintervention due to recurrence of anginal symptoms&#46; The study population was divided into two groups based on whether the patient had developed stent restenosis&#46; They were then stratified into three groups according to their CRP&#47;albumin ratio&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Out of 448 patients&#44; stent restenosis was observed in 24&#46;5&#37; &#40;n&#61;110&#41;&#44; as determined by coronary angiography&#46; Patients with stent restenosis had a higher CRP&#47;albumin ratio&#44; greater platelet distribution width &#40;PDW&#41;&#44; higher CRP levels&#44; and lower levels of both high-density lipoprotein &#40;HDL&#41; cholesterol and serum albumin&#46; The CRP&#47;albumin ratio &#40;OR&#58; 2&#46;289&#44; 95&#37; CI&#58; 1&#46;056-4&#46;959&#59; p&#61;0&#46;036&#41;&#44; stent diameter&#44; PDW and HDL cholesterol levels were found to be independent predictors of stent restenosis&#46; A ROC curve comparison demonstrated that the CRP&#47;albumin ratio was a better predictor of restenosis than either albumin and CRP individually&#44; but it was not better than PDW and HDL cholesterol&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">As a novel inflammation-based risk score&#44; the CRP&#47;albumin ratio may be an easily accessible marker for assessment of stent restenosis risk&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A reestenose de <span class="elsevierStyleItalic">stent</span> permanece como um desafio cl&#237;nico em doentes com cardiopatia isqu&#233;mica&#46; A reestenose de <span class="elsevierStyleItalic">stent</span> est&#225; associada a interven&#231;&#245;es coron&#225;rias recorrentes bem como a aumento de internamentos e de custos m&#233;dicos&#46; A inflama&#231;&#227;o tem um papel significativo&#46; Embora a associa&#231;&#227;o entre reestenose de <span class="elsevierStyleItalic">stent</span> e o aumento dos n&#237;veis de prote&#237;na C-reativa &#40;PCR&#41; e a diminui&#231;&#227;o dos n&#237;veis de albumina tenham sido previamente registados&#44; nenhum estudo pesquisou a possibilidade da PCR&#47;albumina prever um diagn&#243;stico de reestenose de <span class="elsevierStyleItalic">stent</span>&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este estudo retrospetivo incluiu 448 doentes que tinham sido previamente submetidos a interven&#231;&#227;o coron&#225;ria percut&#226;nea prim&#225;ria e que foram referidos para reinterven&#231;&#227;o posterior devido a ressurgimento dos sintomas de angina&#46; A popula&#231;&#227;o do estudo foi dividida em dois grupos com base no facto do doente ter desenvolvido reestenose de <span class="elsevierStyleItalic">stent</span>&#46; Posteriormente&#44; foram estratificados em tr&#234;s grupos de acordo com as rela&#231;&#245;es PCR&#47;albumina&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De um grupo de 448 doentes&#44; a reestenose de <span class="elsevierStyleItalic">stent</span> foi observada em 24&#44;5&#37; &#40;n &#61; 110&#41;&#44; conforme determinado por avalia&#231;&#227;o atrav&#233;s de angiografia coron&#225;ria&#46; Os doentes com reestenose de <span class="elsevierStyleItalic">stent</span> apresentaram uma rela&#231;&#227;o PCR&#47;albumina mais elevada&#44; varia&#231;&#227;o maior do di&#226;metro das plaquetas &#40;DP&#41;&#44; n&#237;veis mais elevados de PCR e n&#237;veis mais baixos de colesterol de lipoprote&#237;nas de alta densidade &#40;HDL&#41; e de albumina s&#233;rica&#46; Os n&#237;veis da rela&#231;&#227;o PCR&#47;albumina &#40;OR&#58; 2&#44;289&#44; IC 95&#37;&#58;1&#44;056 &#8211; 4&#44;959&#59; p &#61; 0&#44;036&#41;&#44; o di&#226;metro do <span class="elsevierStyleItalic">stent</span>&#44; a varia&#231;&#227;o maior do DP e o colesterol HDL foram considerados fatores preditores independentes da restenose de <span class="elsevierStyleItalic">stent</span>&#46; A compara&#231;&#227;o das curvas ROC demonstrou que a rela&#231;&#227;o PCR&#47;albumina constituiu um fator preditor melhor do que a albumina e a PCR&#44; isoladamente&#44; n&#227;o sendo&#44; no entanto&#44; melhor do que o DP e o colesterol HDL&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Como novo <span class="elsevierStyleItalic">score</span> de risco baseado em inflama&#231;&#227;o&#44; a rela&#231;&#227;o PCR&#47;albumina pode ser um marcador facilmente acess&#237;vel para a avalia&#231;&#227;o do risco de reestenose de <span class="elsevierStyleItalic">stent</span>&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
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        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flowchart of enrollment and follow-up of study patients&#46;</p>"
        ]
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      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curves to detect the best variable for predicting stent restenosis&#46; AUC&#58; area under the curve&#59; CRP&#58; C-reactive protein&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristic curves comparing independent predictors of laboratory parameters to detect the best predictor of stent restenosis&#46; AUC&#58; area under the curve&#59; CRP&#58; C-reactive protein&#59; HDL-C&#58; high-density lipoprotein cholesterol&#59; PDW&#58; platelet distribution width&#46;</p>"
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      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">CK-MB&#58; creatine kinase-myocardial band&#59; CRP&#58; C-reactive protein&#59; CX&#58; circumflex artery&#59; eGFR&#58; estimated glomerular filtration rate&#59; HDL-C&#58; high-density lipoprotein cholesterol&#59; IQR&#58; interquartile range &#40;25th-75th percentiles&#41;&#59; IRA&#58; infarct-related artery&#59; LAD&#58; left anterior descending artery&#59; LDL-C&#58; low-density lipoprotein cholesterol&#59; LVEF&#58; left ventricular ejection fraction&#59; PDW&#58; platelet distribution width&#59; RCA&#58; right coronary artery&#59; SR&#58; stent restenosis&#59; STEMI&#58; ST-segment elevation myocardial infarction&#59; WBC&#58; white blood cell&#46;</p>"
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                  \t\t\t\t">56&#177;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">180&#46;0 &#40;40&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">180&#46;0 &#40;53&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;286&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">LVEF&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&#46;51&#177;7&#46;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Total ischemia time&#44; min&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RCA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CX&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Proximal&#47;ostial lesion as IRA&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">High-grade thrombus burden&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Pre-dilatation&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tirofiban infusion n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Stent length&#44; mm</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Stent diameter&#44; mm</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Time from first STEMI to reintervention&#44; months</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Platelet count&#44; 10 000&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Neutrophil count&#44; &#47;1000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lymphocyte count&#44; &#47;1000&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Neutrophil-to-lymphocyte ratio&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Triglycerides&#44; mg&#47;dl&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">115&#46;00 &#91;76&#46;0-167&#46;0&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Glucose on admission&#44; mg&#47;dl&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Proximal&#47;ostial lesion for IRA&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Time from first STEMI to reintervention &#40;months&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Platelet count&#44; 10 000&#47;ml</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Neutrophil count&#44; &#47;1000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lymphocyte count&#44; &#47;1000&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Neutrophil-to-lymphocyte ratio&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Total cholesterol&#44; mg&#47;dl</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Triglycerides&#44; mg&#47;dl&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">120&#46;00 &#91;85&#46;0-183&#46;5&#93;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Glucose on admission&#44; mg&#47;dl&#44; median &#91;IQR&#93;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">eGFR&#44; ml&#47;min&#47;1&#46;73 m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Demographic&#44; clinical&#44; laboratory and coronary angiographic characteristics of the study population stratified according to C-reactive protein&#47;albumin ratio&#46;</p>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
DOI:10.1016/j.repc.2018.08.008
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