Inflammatory Biomarkers for Predicting High SYNTAX and SYNTAX II Scores

Abstract

We read the recent article entitled “Assessment of relationship between C-reactive protein to albumin ratio and coronary artery disease severity in patients with acute coronary syndrome” by Cagdas et al with great interest. They demonstrated that the inflammatory status, reflected by the decreased albumin level, increased C-reactive protein (CRP) level, and higher CRP to albumin ratio (CAR), was closely associated with severe coronary artery disease (CAD) determined using the synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) and SYNTAX II scores. Moreover, they indicated that decreased albumin and increased CAR were independent predictors of high SYNTAX and SYNTAX II scores. SYNTAX score, which was established during the SYNTAX trial, is a helpful tool for treatment decisions regarding the complexity of the (CAD). SYNTAX II provides greater prognostic accuracy in clinical settings for patients with CAD and acute myocardial infarction. Endothelial dysfunction, oxidative stress, and many inflammatory biomarkers play a crucial role in the formation and progression of atherosclerosis. Many easily available inflammatory and oxidative biomarkers including red cell distribution width, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, monocyte to high-density lipoprotein cholesterol ratio, serum total bilirubin, serum uric acid, and serum vitamin D have been demonstrated to be independent risk factors and novel prognostic markers for the extent, severity, and complexity of CAD and cardiovascular events. In their study, Cagdas et al did not report data regarding these easily available hematological and biochemical parameters related to inflammation and oxidative stress. In addition, there was no information regarding medication usage. Finally, the multivariate logistic regression analysis lacks these parameters. So, the study findings regarding independent predictors of a high SYNTAX and SYNTAX II scores may be misleading. In conclusion, we believe that the combined information of multiple inflammatory biomarkers could be useful and more accurate for predicting the severity of CAD.