CONTENT

To the Editor,

The authors¹ are thanked for their interest and valuable comments on the article “Neutrophil Percentage-to-Albumin Ratio as a Predictor of Collateral Circulation in Chronic Total Occlusion.”²

It is a fact that parameters based on the ratio of blood parameters are not included in the current guidelines. We agree with the finding that multicenter and large-population prospective studies on this subject are lacking in the literature. For this reason, biomarkers based on the ratio of blood parameters cannot find a place in today’s guidelines.

In our study, when RCA (right coronary artery) chronic total occlusion, LAD (left anterior descending artery) chronic total occlusion, and CX (left circumflex artery) chronic total occlusion patients were examined within themselves (subgroup analysis), it was seen that the strong relationship between NPAR (neutrophil percentage-to-albumin ratio) and coronary collateral circulation continued. We agree with the justified criticism made at this point; it would have been better if we had stated and discussed this finding in the results and discussion section of our study.

We also totally agree that well-designed, large-scale, prospective, randomized studies are needed to delineate this issue.

Footnotes

Declaration of Interests: The authors have no conflicts of interest to declare.

References

1. Astan R. Neutrophil percentage-to-albumin ratio and coronary collaterals: a true predictor or an overstated association?. Anatol J Cardiol. 2025;29(11):671-672.
2. Aktaş İ, Bolayır HA, Karasu M. Neutrophil percentage-to-albumin ratio as a predictor of collateral circulation in chronic total occlusion. Anatol J Cardiol. 2025;29(9):489-495.