Red Cell Distribution Width/Albumin Ratio as a Valuable Marker to Predict Spontaneous Recanalization in Acute ST-Segment Elevation Myocardial Infarction: A Retrospective Cohort Study

Background This study aimed to evaluate the predictive value of the red cell distribution width/ albumin ratio (RDW/ALB ratio, RAR) for spontaneous recanalization (SR) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods We conducted a retrospective analysis of 353 patients diagnosed with STEMI who were admitted to our institution between January 2019 and April 2022. Based on the thrombolysis in myocardial infarction (TIMI) flow grades in the infarct-related artery (IRA), the patients were divided into two groups: a non-spontaneous recanalization (NSR) group (TIMI 0–1; n = 230) and an SR group (TIMI 2–3; n = 123). The RAR was calculated for each patient, and its association with SR was evaluated using binary logistic regression and receiver operating characteristic (ROC) curve analysis. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). Results Patients in the NSR group had a significantly higher RAR level compared to the SR group (3.34 [3.11, 3.64] vs. 3.18 [2.95, 3.45], P < 0.001). In the multivariable logistic regression analysis adjusted for key confounders including sex, age, white blood cell (WBC), apolipoprotein A1(ApoA1), albumin (ALB), and left ventricular ejection fraction (LVEF), a higher RAR remained an independent predictor for the absence of SR (OR = 2.528, 95% CI: 1.019-6.276). The predictive performance of RAR for SR was modest, with an area under the ROC curve of 0.613 (95% CI: 0.552-0.675), yielding a sensitivity of 53.9% and a specificity of 67.0%. Conclusion Our findings suggest that RAR is a promising biomarker for predicting SR in patients with acute STEMI. It helps us to identify high-risk populations in acute STEMI without SR at an early stage, thereby enhancing our ability for early intervention.