C-Reactive Protein to Albumin Ratio Versus Coronary Artery Ectasia as Predictors of No-reflow After Primary Percutaneous Coronary Intervention for Patients Presenting with ST Segment Elevation Myocardial Infarction

Aims: to assess and compare the significance of C-reactive protein Albumin ratio (CAR) versus coronary artery ectasia (CAE) as predictors of no-reflow phenomenon.

Methods: This study was conducted on 90 ST segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention (PPCI) within 24 hours of presentation at cardiovascular medicine department Tanta university hospitals in Gharbia Governorate, Egypt. This is a prospective study and data collection was done within 12 months started from June 2018. Patients were divided into two groups according to the post primary PCI thrombolysis in myocardial infarction (TIMI) flow score. Group I (Case group), patients with no-reflow phenomenon TIMI 0-1 flow post primary PCI. Group II (Control group) with TIMI flow ≥ 2 after primary PCI. They were subjected to full clinical examination, laboratory investigation including CRP and serum albumin, 12 leads surface ECG, echocardiography and primary percutaneous coronary intervention (PCI).

Results: There was significant statistical difference between both groups as regard age <) 60 years, 96.7% vs 20%, P < 0.001), gender (male, 93.3% vs 63.3%, P = 0.002), ischemia time ) < 6 hours, 100% vs 33.3%, P > 0.001), CRP level (64 ± 32.6 mg/L vs 26.27 ± 21.5 mg/L, P > 0.001), serum albumin (3.22 ± 0.23 g/dL vs 3.55 ± 0.20 g/dL, P > 0.001), CRP albumin ratio (CAR) (0.0204 ± 0.011 vs 0.0076 ± 0.0064, P > 0.001), coronary artery ectasia (30% vs 6.7%, P = 0.003), thrombus grade score )≥ 4, 100% vs 10%, P > 0.001). However, there was no significant statistical difference between both groups as regard smoking, dyslipidemia and revascularization method.

Conclusion: Compared to CAE, CAR is more significant and more reliable to predict no reflow in acute STEMI patients managed by primary PCI within 24 hours of presentation.