İnanç ARTAÇ, Timor OMAR, Muammer KARAKAYALI, Doğan İLİŞ, Öztürk DEMİR, Mehmet Hakan ŞAHİN, Yavuz KARABAĞ, İbrahim RENCÜZOĞULLARI

Assessment of the Relationship Between Serum Albumin to Creatinine Ratio and Long-Term Mortality in Patients with ST-Segment Elevation Myocardial Infarction

Aim: In recent years, an increasing number of evidence suggests that the inflammation plays a significant role in the pathophysiology of ST-segment elevation myocardial infarction (STEMI). The association between inflammatory markers and renal functions in STEMI prognosis has been previously reported. No studies have investigated the ability of the serum albumin to creatinine ratio (sACR), defined as a prognostic score, to predict long term mortality in patients experiencing STEMI. Material and Method: This retrospective study included 1133 patients experiencing STEMI. The study population was divided into two groups according to survival and analyzed whether the sACR was an independent predictor of long-term mortality. Results: Out of 1133 patients, death was observed in 112 patients (9%) an average follow-up of 55 months. During the total follow-up period, patients were divided into two groups according to survival. Compared to the survival group, long-term mortality group was older, had a higher SYNTAX score and a lower sACR (p<0.05). Independent predictors of long-term mortality were found to be age, smoking, LVEF, and sACR (HR: 0.627 95% CI: 0.533–0.737; p<0.001). Receiver operating characteristic (ROC) curve comparisons for long-term mortality demonstrated that the sACR was a better predictor than both albumin and creatinine, separately. Conclusion: The present study revealed that sACR is an independent predictor of long-term mortality in patients experiencing STEMI. As a marker which can be easily obtained and calculated, sACR can be an effective parameter used for prognosis estimation of STEMI.

Keywords:

serum albumin, creatinine, sACR; mortality, ST-segment elevation myocardial infarction,

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1.Hartley A, Marshall DC, Salciccioli JD, Sikkel MB, Maruthappu M, Shalhoub J. Trends in mortality from ischemic heart disease and Cerebrovascular disease in Europe: 1980 to 2009. Circulation. 2016;133(20):1916–26.
2. Puymirat E, Simon T, Steg PG, Schiele F, Gueret P, Blanchard D, et al.; USIK USIC2000 Investigators, FAST MI Investigators. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA. 2012;308(10):998–1006.
3. Gale CP, Allan V, Cattle BA, Hall AS, West RM, Timmis A, et al. Trends in hospital treatments, including revascularization, following acute myocardial infarction, 2003–2010: a multilevel and relative survival analysis for the National Institute for Cardiovascular Outcomes Research (NICOR). Heart. 2014;100(7):582–9.
4. Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J. 2016;37(42):3232– 45.
5. Shao C, Wang J, Tian J, Tang Y-d. Coronary artery disease: from mechanism to clinical practice. Adv Exp Med Biol. 2020;1177:1–36.
6. Paar M, Rossmann C, Nusshold C, Wagner T, Schlagenhauf A, Leschnik B, et al. Anticoagulant action of low, physiologic, and high albumin levels in whole blood. PloS One. 2017;12:e0182997.
7. Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004 NovDec;17(6):432–7.
8. Eckart A, Struja T, Kutz A, Baumgartner A, Baumgartner T, Zurfluh S, et al. Relationship of nutritional status, inflammation and serum albumin levels during acute illness: a prospective study. Am J Med. 2020 Jun;133(6):713–22. e7.
9. Arques S. Human serum albumin in cardiovascular diseases. Eur J Intern Med. 2018;52:8–12.
10. Chien SC, Chen CY, Leu HB, Su CH, Yin WH, Tseng WK, et al. Association of low serum albumin concentration and adverse cardiovascular events in stable coronary heart disease. Int J Cardiol. 2017 Aug 15;241:1–5.
11. González-Pacheco H, Amezcua-Guerra LM, Sandoval J, Martínez-Sánchez C, Ortiz-León XA, Peña-Cabral MA et al. Prognostic implications of serum albumin levels in patients with acute coronary syndromes. Am J Cardiol. 2017 Apr 1;119:951– 8.
12. Plakht Y, Gilutz H, Shiyovich A. Decreased admission serum albumin level is an independent predictor of long-term mortality in hospital survivors of acute myocardial infarction. Soroka acute myocardial infarction II (SAMI-II) project. Int J Cardiol. 2016;219:20–4.
13. Hartopo AB, Gharini PP, Setianto BY. Low serum albumin levels and in-hospital adverse outcomes in acute coronary syndrome. Int Heart J. 2010;51:221–6.
Chi G, Gibson CM, Liu Y, Hernandez AF, Hull RD, Cohen AT, et al. Inverse relationship of serum albumin to the risk of venous thromboembolism among acutely ill hospitalized patients: analysis from the APEX trial. Am J Hematol. 2019;94:21e8.
15. Pignatelli P, Farcomeni A, Menichelli D, Pastori D, Violi F. Serum albumin and risk of cardiovascular events in primary and secondary prevention: a systematic review of observational studies and Bayesian meta-regression analysis. Int Emerg Med. 2020;15:135e43.
16. Tsai TT, Patel UD, Chang TI, Kennedy KF, Masoudi FA, Matheny ME, et al. Contemporary incidence, predictors, and outcomes of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the NCDR Cath-PCI registry. JACC Cardiovasc Interv. 2014 Jan;7:1–9.
17. Zhao L, Wang L, Zhang Y. Elevated admission serum creatinine predicts poor myocardial blood flow and one-year mortality in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. J Invasive Cardiol. 2009;21:493–8.
18. McCullough PA, Soman SS, Shah SS, Smith ST, Marks KR, Yee J et al. Risks associated with renal dysfunction in patients in the coronary care unit. J Am Coll Cardiol. 2000;36:679–84.
19. Yamaguchi J, Kasanuki H, Ishii Y, Yagi M, Nagashima M, Fujii S, et al. Serum creatinine on admission predicts long-term mortality in acute myocardial infarction patients undergoing successful primary angioplasty: data from the Heart Institute of Japan Acute Myocardial Infarction (HIJAMI) Registry. Circ J. 2007 Sep;71(9):1354–9.
20. Liu H, Zhang J, Yu J, Li D, Jia Y, Cheng Y, et al. Prognostic value of serum albumin-to-creatinine ratio in patients with acute myocardial infarction: Results from the retrospective evaluation of acute chest pain study. Medicine (Baltimore). 2020 Aug 28;99(35):e22049.
21. Weber C, Noels H. Atherosclerosis: current pathogenesis and therapeutic options. Nat Med. 2011 Nov 7;17(11):1410–22.
22. Tousoulis D, Economou EK, Oikonomou E, Papageorgiou N, Siasos G, Latsios G, et al. The role and predictive value of cytokines in atherosclerosis and coronary artery disease. Curr Med Chem. 2015;22(22):2636–50.
23. Mallika V, Goswami B, Rajappa M. Atherosclerosis pathophysiology and the role of novel risk factors: a clinicobiochemical perspective. Angiology. 2007 OctNov;58(5):513–22. Ikonomidis I, Michalakeas CA, Parissis J, Paraskevaidis I, Ntai K, Papadakis I, et al. Inflammatory markers in coronary artery disease. Biofactors. 2012 Sep-Oct;38(5):320–8.
25. De Simone G, di Masi A, Ascenzi P. Serum albumin: a multifaced enzyme. Int J Mol Sci. 2021 Sep 28;22(18):10086.
26. Arques S. Serum albumin and cardiovascular diseases: A comprehensive review of the literature. Ann Cardiol Angeiol (Paris). 2018 Apr;67(2):82–90.
27. Bicciré FG, Pastori D, Tanzilli A, Pignatelli P, Viceconte N, Barillà F, et al. Low serum albumin levels and in-hospital outcomes in patients with ST-segment elevation myocardial infarction. Nutr Metab Cardiovasc Dis. 2021 Sep 22;31(10):2904–11.
28. Kurtul A, Murat SN, Yarlioglues M, Duran M, Ocek AH, Koseoglu C, et al. Usefulness of serum albumin concentration to predict high coronary SYNTAX score and in-hospital mortality in patients with acute coronary syndrome. Angiology. 2016 Jan;67(1):34–40.
29. Kurtul A, Ocek AH, Murat SN, Yarlioglues M, Demircelik MB, Duran M, et al. Serum albumin levels on admission are associated with angiographic no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. Angiology. 2015 Mar;66(3):278–85.
30. Xia M, Zhang C, Gu J, Chen J, Wang LC, Lu Y, et al. Impact of serum albumin levels on long-term all-cause, cardiovascular, and cardiac mortality in patients with first-onset acute myocardial infarction. Clin Chim Acta. 2018 Feb;477:89–93.
31. Quinlan GJ, Martin GS, Evans TW. Albumin: biochemical properties and therapeutic potential. Hepatology. 2005 Jun;41(6):1211–9.
32. Sadeghi HM, Stone GW, Grines CL, Mehran R, Dixon SR, Lansky AJ, et al. Impact of renal insufficiency in patients undergoing primary angioplasty for acute myocardial infarction. Circulation 2003 Dec 12;108(22):2769–75.
33. Smith GL, Masoudi FA, Shlipak MG, Krumholz HM, Parikh CR. Renal impairment predicts long-term mortality risk after acute myocardial infarction. J Am Soc Nephrol. 2008 Jan;19(1):141–50.