Relationship between c-reactive protein to albumin ratio and coronary artery calcium score and CAD-RADS scores with coronary computed tomography angiography

Relationship between c-reactive protein to albumin ratio and coronary artery calcium score and CAD-RADS scores with coronary computed tomography angiography

Background/aim: C-reactive protein (CRP) to albumin ratio (CAR) is predictive marker of systemic inflammatory state in atherosclerotic coronary diseases when compared to predictive value of these two markers separately. We aimed to evaluate the relationship between CAR and the coronary artery calcium (CAC) score, Coronary Artery Disease-Reporting and Data System (CAD-RADS) score in patients’ unknown diagnosis of coronary artery disease (CAD) underwent coronary CTA (Computed Tomography Angiography) and were classified by CAD-RADS scores. Materials and methods: A total of 187 patients consecutively referred for the evaluation of their chest pain underwent coronary CTA were included retrospectively. Results: CRP, CAR, and CAD-RADS scores were higher in patients with CAC score > 400 than the other groups (p < 0.001). We found positive correlation between CAR and CAC score (r= 0.384, p < 0.001), and also there was a positive correlation between CAR and CAD-RADS score (r= 0.462, p < 0.001). Multivariate logistic regression analyses showed that low density lipoprotein cholesterol (LDL-C), CAD-RADS score, and CAR were independent predictors of CAC score (p < 0.05). Conclusion: Higher CAR can be a predictive marker of atherosclerosis and CAD. CAR may be useful in the management of patients before invasive coronary angiography. Further studies are needed to clarify the pathophysiologic role of CAR in patients with atherosclerotic coronary heart diease.Key words: Coronary calcium score, CAD-RADS score, coronary computed tomography angiography, serum C-reactive protein to albumin ratio

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  • 1. Meijboom WB, Meijs MF, Schuijf JD, Cramer MJ, Mollet NR et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. Journal of the American College of Cardiology 2008; 52(25): 2135-2144. doi:10.1016/j.jacc.2008.08.058
  • 2. Ramanathan S, Al Heidous M, Alkuwari M. Coronary Artery Disease-Reporting and Data System (CAD-RADS): strengths and limitations. Clinical Radiology 2019; 74(6): 411-417. doi:10.1016/j.crad.2019.01.003
  • 3. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal 2020; 41(3): 407-477. doi:10.1093/eurheartj/ehz425
  • 4. Bittencourt MS, Hulten E, Ghoshhajra B, O’Leary D, Christman MP et al. Prognostic value of nonobstructive and obstructive coronary artery disease detected by coronary computed tomography angiography to identify cardiovascular events. Circulation Cardiovascular Imaging 2014; 7(2): 282- 291. doi:10.1161/CIRCIMAGING.113.001047
  • 5. Hadamitzky M, Achenbach S, Al-Mallah M, Berman D, Budoff M et al. Optimized prognostic score for coronary computed tomographic angiography: results from the CONFIRM registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry). Journal of the American College of Cardiology 2013; 62(5): 468-476. doi:10.1016/j.jacc.2013.04.064
  • 6. Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS et al. CAD-RADS: Coronary Artery Disease - Reporting and Data System: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. Journal of the American College of Radiology : JACR 2016; 13(12 Pt A): 1458-1466 e1459. doi:10.1016/j.jacr.2016.04.024
  • 7. Xie JX, Cury RC, Leipsic J, Crim MT, Berman DS et al. The Coronary Artery Disease-Reporting and Data System (CADRADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting. JACC Cardiovascular Imaging 2018; 11(1): 78-89. doi:10.1016/j.jcmg.2017.08.026
  • 8. Huang W, Lim LMH, Aurangzeb AS, Wong CJ, Koh NSY et al. Performance of the coronary calcium score in an outpatient chest pain clinic and strategies for risk stratification. Clinical Cardiology 2021; 44(2): 267-275. doi:10.1002/clc.23539
  • 9. Fernandez-Friera L, Garcia-Alvarez A, BagheriannejadEsfahani F, Malick W, Mirelis JG et al. Diagnostic value of coronary artery calcium scoring in low-intermediate risk patients evaluated in the emergency department for acute coronary syndrome. The American Journal of Cardiology 2011; 107(1): 17-23. doi:10.1016/j.amjcard.2010.08.037
  • 10. Pepys MB, Baltz ML. Acute phase proteins with special reference to C-reactive protein and related proteins (pentaxins) and serum amyloid A protein. Advances in Immunology 1983; 34: 141-212. doi:10.1016/s0065-2776(08)60379-x
  • 11. Wilson AM, Swan JD, Ding H, Zhang Y, Whitbourn RJ et al. Widespread vascular production of C-reactive protein (CRP) and a relationship between serum CRP, plaque CRP and intimal hypertrophy. Atherosclerosis 2007; 191(1): 175-181. doi:10.1016/j.atherosclerosis.2006.03.034
  • 12. Ritchie RF, Palomaki GE, Neveux LM, Navolotskaia O, Ledue TB et al. Reference distributions for the negative acute-phase serum proteins, albumin, transferrin and transthyretin: a practical, simple and clinically relevant approach in a large cohort. Journal of Clinical Laboratory Analysis 1999; 13(6): 273-279. doi:10.1002/(sici)1098-2825(1999)13:6<273::aidjcla4>3.0.co;2-x
  • 13. Rencuzogullari I, Karabag Y, Cagdas M, Karakoyun S, Seyis S et al. Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction. Revista Portuguesa de Cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese Journal of Cardiology : an official journal of the Portuguese Society of Cardiology 2019; 38(4): 269-277. doi:10.1016/j.repc.2018.08.008
  • 14. Cagdas M, Rencuzogullari I, Karakoyun S, Karabag Y, Yesin M et al. Assessment of Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Artery Disease Severity in Patients With Acute Coronary Syndrome. Angiology 2019; 70(4): 361-368. doi:10.1177/0003319717743325
  • 15. Wang W, Ren D, Wang CS, Li T, Yao HC et al. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomarkers in Medicine 2019; 13(10): 811-820. doi:10.2217/bmm-2018-0346
  • 16. Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. Journal of the American College of Cardiology 2007; 49(3): 378-402. doi:10.1016/j.jacc.2006.10.001
  • 17. Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS et al. Coronary Artery Disease - Reporting and Data System (CADRADS): An Expert Consensus Document of SCCT, ACR and NASCI: Endorsed by the ACC. JACC Cardiovascular Imaging 2016; 9(9): 1099-1113. doi:10.1016/j.jcmg.2016.05.005
  • 18. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002; 105(9): 1135-1143.
  • 19. Akalin Ciftci G, Ertorun I, Akalin A, Alatas IO, Musmul A. The effects of atorvastatin on antioxidant/antiinflammatory properties of HDLs in hypercholesterolemics. Turkish Journal of Medical Sciences 2015; 45(2): 345-351. doi:10.3906/sag1311-91
  • 20. Akboga MK, Yayla C, Balci KG, Ozeke O, Maden O et al. Relationship between Serum Albumin Level and Monocyteto-High-Density Lipoprotein Cholesterol Ratio with Saphenous Vein Graft Disease in Coronary Bypass. The Thoracic and Cardiovascular Surgeon 2017; 65(4): 315-321. doi:10.1055/s-0036-1582260
  • 21. Torzewski J, Torzewski M, Bowyer DE, Frohlich M, Koenig W et al. C-reactive protein frequently colocalizes with the terminal complement complex in the intima of early atherosclerotic lesions of human coronary arteries. Arteriosclerosis, Thrombosis, and Vascular Biology 1998; 18(9): 1386-1392. doi:10.1161/01.atv.18.9.1386
  • 22. Torzewski M, Rist C, Mortensen RF, Zwaka TP, Bienek M et al. C-reactive protein in the arterial intima: role of C-reactive protein receptor-dependent monocyte recruitment in atherogenesis. Arteriosclerosis, Thrombosis, and Vascular Biology 2000; 20(9): 2094-2099. doi:10.1161/01.atv.20.9.2094
  • 23. Pasceri V, Willerson JT, Yeh ET. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation 2000; 102(18): 2165-2168. doi:10.1161/01.cir.102.18.2165
  • 24. Verma S, Wang CH, Li SH, Dumont AS, Fedak PW, et al. A self-fulfilling prophecy: C-reactive protein attenuates nitric oxide production and inhibits angiogenesis. Circulation 2002; 106(8): 913-919. doi:10.1161/01.cir.0000029802.88087.5e
  • 25. Arroyo-Espliguero R, Avanzas P, Cosin-Sales J, Aldama G, Pizzi C et al. C-reactive protein elevation and disease activity in patients with coronary artery disease. European Heart Journal 2004; 25(5): 401-408. doi:10.1016/j.ehj.2003.12.017
  • 26. Quaglia LA, Freitas W, Soares AA, Santos RA, Nadruz W et al. C-reactive protein is independently associated with coronary atherosclerosis burden among octogenarians. Aging Clinical and Experimental Research 2014; 26(1): 19-23. doi:10.1007/ s40520-013-0114-x
  • 27. Mani P, Puri R, Schwartz GG, Nissen SE, Shao M et al. Association of Initial and Serial C-Reactive Protein Levels With Adverse Cardiovascular Events and Death After Acute Coronary Syndrome: A Secondary Analysis of the VISTA-16 Trial. JAMA Cardiology 2019; 4(4): 314-320. doi:10.1001/ jamacardio.2019.0179
  • 28. Mukai H, Villafuerte H, Qureshi AR, Lindholm B, Stenvinkel P. Serum albumin, inflammation, and nutrition in end-stage renal disease: C-reactive protein is needed for optimal assessment. Seminars in Dialysis 2018; 31(5): 435-439. doi:10.1111/ sdi.12731
  • 29. Mikhailidis DP, Ganotakis ES. Plasma albumin and platelet function: relevance to atherogenesis and thrombosis. Platelets 1996; 7(3): 125-137. doi:10.3109/09537109609023571
  • 30. Oduncu V, Erkol A, Karabay CY, Kurt M, Akgun T et al. The prognostic value of serum albumin levels on admission in patients with acute ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary intervention. Coronary Artery Disease 2013; 24(2): 88-94. doi:10.1097/ MCA.0b013e32835c46fd
  • 31. Kurtul A, Murat SN, Yarlioglues M, Duran M, Ocek AH et al. Usefulness of Serum Albumin Concentration to Predict High Coronary SYNTAX Score and In-Hospital Mortality in Patients With Acute Coronary Syndrome. Angiology 2016; 67(1): 34-40. doi:10.1177/0003319715575220
  • 32. Tintut Y, Alfonso Z, Saini T, Radcliff K, Watson K et al. Multilineage potential of cells from the artery wall. Circulation 2003; 108(20): 2505-2510. doi:10.1161/01. CIR.0000096485.64373.C5
  • 33. Tyson KL, Reynolds JL, McNair R, Zhang Q, Weissberg PL et al. Osteo/chondrocytic transcription factors and their target genes exhibit distinct patterns of expression in human arterial calcification. Arteriosclerosis, Thrombosis, and Vascular Biology 2003; 23(3): 489-494. doi:10.1161/01. ATV.0000059406.92165.31
  • 34. Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Coronary Calcium Score and Cardiovascular Risk. Journal of the American College of Cardiology 2018; 72(4): 434-447. doi:10.1016/j.jacc.2018.05.027
  • 35. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 2003; 228(3): 826-833. doi:10.1148/radiol.2283021006
  • 36. Min JK, Dunning A, Lin FY, Achenbach S, Al-Mallah M et al. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. Journal of the American College of Cardiology 2011; 58(8): 849-860. doi:10.1016/j.jacc.2011.02.074
  • 37. van Rosendael AR, Shaw LJ, Xie JX, Dimitriu-Leen AC, Smit JM et al. Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk Score. JACC Cardiovascular Imaging 2019; 12(10): 1987-1997. doi:10.1016/j.jcmg.2018.10.024
  • 38. Fairclough E, Cairns E, Hamilton J, Kelly C. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clinical Medicine 2009; 9(1): 30- 33. doi:10.7861/clinmedicine.9-1-30
  • 39. Karabag Y, Cagdas M, Rencuzogullari I, Karakoyun S, Artac I et al. Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. Journal of Clinical Laboratory Analysis 2018; 32(7): e22457. doi:10.1002/jcla.22457
  • 40. Yayla C, Gayretli Yayla K. C-Reactive Protein to Albumin Ratio in Patients With Saphenous Vein Graft Disease. Angiology 2021: 3319721998863. doi:10.1177/0003319721998863
  • 41. Calik AN, Inan D, Karatas MB, Akdeniz E, Genc D et al. The association of preprocedural C-reactive protein/albumin ratio with in-stent restenosis in patients undergoing iliac artery stenting. Journal of Cardiovascular and Thoracic Research 2020; 12(3): 179-184. doi:10.34172/jcvtr.2020.31
  • 42. Cinar T, Cagdas M, Rencuzogullari I, Karakoyun S, Karabag Y et al. Prognostic efficacy of C-reactive protein/albumin ratio in ST elevation myocardial infarction. Scandinavian Cardiovascular Journal : SCJ 2019; 53(2): 83-90. doi:10.1080/ 14017431.2019.1590628
  • 43. Dereli S, Cerik IB, Kaya A, Bektas O. Assessment of the Relationship Between C-Reactive Protein-toAlbumin Ratio and the Presence and Severity of Isolated Coronary Artery Ectasia. Angiology 2020; 71(9): 840-846. doi:10.1177/0003319720930983
  • 44. Acet H, Guzel T, Aslan B, Isik MA, Ertas F et al. Predictive Value of C-Reactive Protein to Albumin Ratio in ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention. Angiology 2021; 72(3): 244-251. doi:10.1177/0003319720963697
Turkish Journal of Medical Sciences-Cover
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  • Yayın Aralığı: Yılda 6 Sayı
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