Dear EditorI read the recently published article entitled "Systemic Immune-Inflammation Index and C-Reactive Protein/Albumin Ratio Could Predict Acute Stent Thrombosis and High SYNTAX Score in Acute Coronary Syndrome" with great interest. 1 The authors demonstrated that the systemic immune-inflammation index (SII) and C-reactive protein (CRP) to albumin ratio (CAR) were independent predictors of acute stent thrombosis (AST) and high SYNTAX score in patients with the acute coronary syndrome (ACS). They also showed significant positive correlations between the SYNTAX score with SII and CRP. 1 Previous studies reported that serum total bilirubin, resting heart rate, vitamin D, and the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes mellitus, previous stroke or transient ischemic attack [doubled], vascular disease, age 65 to 74 years, female gender) score were independent risk factors and novel prognostic markers for cardiovascular events, in-hospital mortality as well as the extent, severity, and complexity of coronary artery disease (CAD) assessed by SYNTAX score. [2][3][4][5][6] The authors 1 did not report these parameters in their study, and they did not analyze these possible confounding factors in the multivariate logistic regression model. Moreover, recent studies also pointed out that an increased monocyte count and decreased high-density lipoprotein cholesterol (HDL-C) level as well as a high monocyte to HDL-C ratio (MHR), robust and reliable indicators of inflammatory status, were closely associated with severe CAD assessed by SYNTAX score, in-stent restenosis, and saphenous vein graft disease. [7][8][9] The authors 1 considered several easily available hematological parameters of the study population; however, monocytes and MHR values are not listed in Table 2 and these values were not analyzed in the multivariate logistic regression model.In conclusion, I suggest that their study findings should be evaluated for both the presence and severity of CAD after considering the variables mentioned above.
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