Abstract
Celik et al 1 in their paper entitled “Preprocedural Albumin Levels and Risk of In-Stent Restenosis After Coronary Stenting With Bare-Metal Stent” demonstrated that a low preprocedural albumin level was an independent and significant predictor of higher in-stent restenosis in patients after bare metal stent (BMS) placement.
The degree of inflammatory status is inversely associated with the serum albumin levels. 2 Inflammation has been associated with decreasing albumin synthesis and increasing catabolism. 3 In addition, hypoalbuminemia may increase blood viscosity and disrupt endothelial function. 4 An association between lower serum albumin levels and increased cardiovascular (CV) morbidity and mortality has been seen in previous studies. 5 –8
Recently, the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio have been used as independent predictors of in-stent restenosis. 9 –11 However, Celik et al 1 did not evaluate the combinations of these easily calculated inflammatory markers. Furthermore, they did not indicate which confounding factors were tested in the multivariate regression model. Additionally, these markers were not included in the multivariate logistic regression analysis. Therefore, the study findings as regards independent predictors of in-stent restenosis may not be adequately established.
In conclusion, albumin levels may be a novel predictor biomarker for CV diseases especially in in-stent restenosis. However, its role in CV diseases and in-stent restenosis among patients treated successfully with BMS should be assessed after considering several confounding factors.