Association of the C–Reactive Protein to Albumin Ratio with the No–Reflow Phenomenon After Percutaneous Coronary Intervention: A Systematic Review and Meta–analysis

The no-reflow (NR) phenomenon, a complication of percutaneous coronary intervention (PCI), is associated with poor cardiovascular outcomes. Identifying reliable predictors of NR is crucial for risk stratification and improving clinical outcomes. The C-reactive protein (CRP) to albumin ratio (CAR), a marker of systemic inflammation, has been proposed as a potential predictor of NR. This systematic review and meta-analysis aimed to evaluate the relationship between CAR and NR following PCI. A comprehensive literature search was conducted in the Cochrane, Embase, and PubMed databases, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Studies assessing the predictive value of CAR for NR were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using Cochrane's Q and I² statistics. Four studies comprising a total of 2,068 patients were included. The pooled analysis showed a significant association between elevated CAR and an increased risk of NR (OR: 2.34; 95% CI: 1.19–4.60; P = 0.01; I2 = 96%). Elevated CAR is associated with an increased risk of NR after PCI, indicating its potential as a prognostic biomarker. However, the high heterogeneity among studies highlights the need for large-scale research to confirm its clinical applicability.