Association of Platelet–Albumin–Bilirubin and Albumin–Bilirubin Scores with Angiographic No-Reflow in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI
4 affiliations
- 1Department of Cardiology, School of Medicine, Muğla Sıtkı Koçman University, 48000 Muğla, Turkey
- 2Department of Cardiology, Lokman Hekim Akay Hospital, 06700 Ankara, Turkey
- 3Department of Cardiology, Kırşehir Training and Research Hospital, 40100 Kırşehir, Turkey
- 4Department of Cardiology, Ankara Etlik City Hospital, 06170 Ankara, Turkey
Abstract
Background: The platelet–albumin–bilirubin (PALBI) and albumin–bilirubin (ALBI) scores integrate routinely available laboratory parameters with potential relevance to microvascular injury. We investigated their associations with angiographic no-reflow and incremental predictive value in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: This retrospective, single-center study included 1539 consecutive patients with STEMI undergoing primary PCI. No-reflow was defined by final TIMI flow < 3 and/or myocardial blush grade 0–1 in the absence of a mechanical cause. Associations of PALBI and ALBI with no-reflow were assessed using multivariable logistic regression. Discrimination, calibration, reclassification, internal bootstrap validation, and restricted cubic spline analyses were performed. Results: No-reflow occurred in 146 patients (9.5%). Both PALBI (adjusted odds ratio [aOR] per 0.1-point increase, 1.315; 95% confidence interval [CI], 1.228–1.408; p < 0.001) and ALBI (aOR, 1.165; 95% CI, 1.115–1.218; p < 0.001) were independently associated with no-reflow. PALBI showed greater discrimination than ALBI (AUC, 0.722 vs. 0.681; DeLong p = 0.018). Adding PALBI to the clinical model increased the AUC from 0.688 to 0.785 (ΔAUC = 0.098; p = 0.001), with significant NRI (0.777) and IDI (0.102), and improved the Brier score from 0.083 to 0.073. The optimism-corrected AUC was 0.762. PALBI demonstrated a non-linear association with no-reflow (p for non-linearity <0.001), whereas ALBI showed a predominantly linear association. Conclusions: Higher PALBI and ALBI scores were independently associated with angiographic no-reflow after primary PCI in STEMI. PALBI demonstrated stronger discrimination and incremental predictive performance; however, external validation and prospective evaluation are required to determine its potential clinical utility.
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BibTeX
@article{ozlek2026association,
title = {{Association of Platelet–Albumin–Bilirubin and Albumin–Bilirubin Scores with Angiographic No-Reflow in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI}},
author = {Bülent Özlek and Veysel Ozan Tanık and Alperen Taş and Sena Tokatlı and Mehmet Taha Özkan and Kürşat Akbuğa and Yusuf Bozkurt Şahin and Murat Akdoğan and Çağatay Tunca and Betül Akıncıoğlu},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207871},
url = {https://www.mdpi.com/2077-0383/15/20/7871},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of Platelet–Albumin–Bilirubin and Albumin–Bilirubin Scores with Angiographic No-Reflow in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI
AU - Bülent Özlek
AU - Veysel Ozan Tanık
AU - Alperen Taş
AU - Sena Tokatlı
AU - Mehmet Taha Özkan
AU - Kürşat Akbuğa
AU - Yusuf Bozkurt Şahin
AU - Murat Akdoğan
AU - Çağatay Tunca
AU - Betül Akıncıoğlu
PY - 2026
DA - 2026/10/12
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207871
UR - https://www.mdpi.com/2077-0383/15/20/7871
AB - Background: The platelet–albumin–bilirubin (PALBI) and albumin–bilirubin (ALBI) scores integrate routinely available laboratory parameters with potential relevance to microvascular injury. We investigated their associations with angiographic no-reflow and incremental predictive value in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: This retrospective, single-center study included 1539 consecutive patients with STEMI undergoing primary PCI. No-reflow was defined by final TIMI flow < 3 and/or myocardial blush grade 0–1 in the absence of a mechanical cause. Associations of PALBI and ALBI with no-reflow were assessed using multivariable logistic regression. Discrimination, calibration, reclassification, internal bootstrap validation, and restricted cubic spline analyses were performed. Results: No-reflow occurred in 146 patients (9.5%). Both PALBI (adjusted odds ratio [aOR] per 0.1-point increase, 1.315; 95% confidence interval [CI], 1.228–1.408; p < 0.001) and ALBI (aOR, 1.165; 95% CI, 1.115–1.218; p < 0.001) were independently associated with no-reflow. PALBI showed greater discrimination than ALBI (AUC, 0.722 vs. 0.681; DeLong p = 0.018). Adding PALBI to the clinical model increased the AUC from 0.688 to 0.785 (ΔAUC = 0.098; p = 0.001), with significant NRI (0.777) and IDI (0.102), and improved the Brier score from 0.083 to 0.073. The optimism-corrected AUC was 0.762. PALBI demonstrated a non-linear association with no-reflow (p for non-linearity <0.001), whereas ALBI showed a predominantly linear association. Conclusions: Higher PALBI and ALBI scores were independently associated with angiographic no-reflow after primary PCI in STEMI. PALBI demonstrated stronger discrimination and incremental predictive performance; however, external validation and prospective evaluation are required to determine its potential clinical utility.
SN - 2077-0383
ER -