Linglong Fan

Abstract: The C-reactive protein (CRP)/albumin (ALB) ratio (CAR), a key marker of inflammation and nutrition is closely associated with the risk of cardiovascular events. CAR’s potential to predict major adverse cardiovascular events (MACE) in elderly individuals with chronic total occlusion (CTO) has not been evaluated. Therefore, the aim of this study was to elucidate the correlation between CAR and the risk of MACE in elderly patients with CTO. This prospective cohort study consecutively included 134 patients with CTO. ALB and CRP concentrations were measured after patient admission, and CAR was calculated. Patients were followed up by telephone for a median period of 12 months and categorized into a MACE group (41 patients) and a no-MACE group (93 patients) according to the occurrence of MACE during the follow-up period. The relationship between CAR and the risk of MACE was analyzed by COX regression, and the performance of ALB, CRP, and CAR in predicting the risk of MACE was assessed using ROC curve. Kaplan-Meier survival curves were used to analyze patient survival, with subgroup analysis based on CAR. The incidence of MACE in 134 CTO patients was 30.60%. ALB (HR, 0.693; 95% CI, 0.588–0.861; P = 0.001) and CAR (HR, 1.128; 95% CI, 1.050–1.212; P = 0.001) were shown to be independent predictors of MACE in patients with CTO. The AUC for CAR was 0.807, surpassing the AUCs of CRP at 0.766 and ALB at 0.700 individually. The ROC curve indicated that the optimal value to distinguish between MACE and no-MACE groups was 0.1210. Patients with CAR ≥ 0.1210 and ALB < 35.86 g/L had a significantly higher risk of MACE over 2 years (P < 0.001). Final subgroup analysis showed no significant interaction between CAR and each subgroup (interaction P: 0.056–0.859). CAR independently predicts MACE in CTO patients and provides superior prognostic value compared to using CRP or ALB alone.