Inflammatory and Atherogenic Markers as Predictors of Coronary Artery Disease in Patients with Suspected Coronary Artery Disease Undergoing Coronary Angiography

Abstract

Background:

Coronary artery disease (CAD) remains a leading cause of death worldwide, with inflammation playing a key role in its pathophysiology. Inflammatory biomarkers may offer valuable insights into disease mechanisms and risk stratification, potentially informing therapeutic decisions.

Objectives:

This study aimed to investigate the association between key inflammatory markers — C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) — and both the presence and severity of coronary artery stenosis (CAS) in patients with suspected CAD undergoing coronary angiography.

Methods:

This retrospective study included 767 patients referred for coronary angiography due to suspected CAD. The primary outcome was the presence of significant CAS. Demographic data, medical history, and blood samples were collected. Statistical analyses included descriptive methods and regression modeling as well as receiver operating characteristic (ROC) curve analysis to determine optimal cutoff values for biomarkers, with area under the curve (AUC) used to assess predictive performance. A p-value < 0.05 was considered statistically significant.

Results:

Of the 767 patients (mean age 58.3±12.4 years; 56.7% men), 496 had significant CAS (≥ 50%) and 271 had nonsignificant CAS (< 50%). Levels of CRP (0.44 vs. 0.13 mg/dL, p = 0.01) and NLR (2.6 vs. 2.0, p = 0.05) were significantly higher in patients with CAS. No significant difference was observed for PLR (129.4 vs. 118.6, p = 0.13). In multivariable analysis, CRP (OR = 1.188, p = 0.044) and NLR (OR=1.567, p = 0.03) were identified as independent predictors of significant CAS. However, ROC curve analysis showed limited discriminative ability for both CRP (AUC = 0.526) and NLR (AUC = 0.510), with values only slightly above chance.

Conclusion:

Increased levels of CRP and NLR are significantly associated with CAS and may serve as potential biomarkers for detecting CAD.