Low serum albumin levels and in-hospital adverse outcomes in acute coronary syndrome

Risk factors of major lower limb amputation in symptomatic peripheral artery disease: a retrospective cohort study

AIM

To find risk factors of major amputation in patients with peripheral artery disease (PAD) by a combination of both personal risk factors and treatment.

METHODS

This was a retrospective cohort study enrolled adult patients diagnosed as symptomatic PAD. Predictors for major amputation were analyzed.

RESULTS

There were 221 patients with PAD met the study criteria; 28 patients (12.67%) had major amputation events. There were three independent factors Rutherford classification, white blood cell, and serum albumin. The adjusted odds ratio (95% confidence interval) of these factors were 1.824 (1.118, 2.976), 1.073 (1.019, 1.131), and 0.421 (0.202, 0.879), respectively.

CONCLUSIONS

Serum albumin was modifiable to prevent future major amputation in patients with PAD.

The HALP score predicts no-reflow phenomenon and long-term prognosis in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

INTRODUCTION AND OBJECTIVE

Despite recent advances in the management of ST-segment elevation myocardial infarction (STEMI), the clinical outcome of some patients is still unsatisfactory. Therefore, early evaluation to identify high-risk individuals in STEMI patients is essential. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, as a new indicator that can reflect both nutritional status and inflammatory state of the body, can provide prognostic information. In this context, the present study was designed to investigate the relationship between HALP scores assessed at admission and no-reflow as well as long-term outcomes in patients with STEMI.

MATERIAL AND METHODS

A total of 1040 consecutive STEMI patients undergoing primary PCI were enrolled in this retrospective study. According to the best cutoff value of HALP score of 40.11, the study samples were divided into two groups. The long-term prognosis was followed up by telephone.

RESULTS

Long-term mortality was significantly higher in patients with HALP scores lower than 40.11 than in those higher than 40.11. The optimal cutoff value of HALP score for predicting no-reflow was 41.38, the area under the curve (AUC) was 0.727. The best cutoff value of HALP score for predicting major adverse cardiovascular events (MACE) was 40.11, the AUC was 0.763. The incidence of MACE and all-cause mortality was higher in the HALP score <40.11 group.

CONCLUSION

HALP score can independently predict the development of no-reflow and long-term mortality in STEMI patients undergoing PCI.

Improvement of Physical Functions in Elderly Patients with Heart Failure Depends on the Hepatic Reserve

OBJECTIVES

In recent years, the number of elderly heart failure patients with multiorgan failure has been increasing. Furthermore, the combination of heart failure and decreased hepatic reserve can cause severe skeletal muscle impairment and decreased survival rates. This study investigated whether the degree of improvement in the five repetitions of sit-to-stand (5STS) and walking speed (WS) differs depending on hepatic reserve in elderly heart failure patients.

METHODS

The patients were divided into the following two groups: good hepatic reserve (albumin-bilirubin score [ALBI score] ≤-2.25) and poor hepatic reserve (ALBI score >-2.25). Propensity score matching was performed using the brain natriuretic peptide level. A two-way analysis of variance (ANOVA) was performed to examine the main effects of the hepatic reserve and time points (admission or discharge).

RESULTS

After propensity score matching, 28 out of the 33 (84.8%) patients in the good hepatic reserve (age, 83.74 ± 9.25 years and ALBI score, -2.55 ± 0.19 points) and 27 out of 40 (67.5%)patients in the poor hepatic reserve (age, 85.85 ± 7.53 years and ALBI score, -1.93 ± 0.26 points) were analyzed. Two-way ANOVA showed that the 5STS (p = 0.04) and WS (p = 0.01) in poor hepatic reserve tended to be worse than in good hepatic reserve. Furthermore, the 5STS (p = 0.04) and WS tended to improve at discharge in both groups. However, the improvement in WS was not significant (p = 0.15).

CONCLUSIONS

Our study suggests that the hepatic reserve in elderly heart failure patients may be an important factor in the assessment of physical functions.

Association of Serum AGR With All-Cause and Cause-Specific Mortality Among Individuals With Diabetes

CONTEXT

There are insufficient data to support a link between serum albumin-to-globulin ratio (AGR) and mortality in individuals with diabetes.

OBJECTIVE

This prospective study sought to investigate the relationship between serum AGR and all-cause and cause-specific mortality in adult diabetics.

METHODS

This study included 8508 adults with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Death outcomes were ascertained by linkage to National Death Index records through December 31, 2019. Hazard ratios (HR) and 95% CIs for mortality from all causes, cardiovascular disease (CVD), and cancer were estimated using weighted Cox proportional-hazards models.

RESULTS

A total of 2415 all-cause deaths, including 688 CV deaths and 413 cancer deaths, were recorded over an average of 9.61 years of follow-up. After multivariate adjustment, there was a significant and linear relationship between higher serum AGR levels and reduced all-cause and cause-specific mortality in a dose-response manner. The multivariate-adjusted HR and 95% CI for all-cause mortality (Ptrend < .0001), cardiovascular mortality (Ptrend < .001), and cancer mortality (Ptrend < .01) were 0.51 (0.42-0.60), 0.62 (0.46-0.83), and 0.57 (0.39-0.85), respectively, for individuals in the highest AGR quartile. There was a 73% decreased risk of all-cause death per 1-unit rise in natural log-transformed serum AGR, as well as a 60% and 63% decreased risk of mortality from CVD and cancer, respectively (all P < .001). Both the stratified analysis and the sensitivity analyses revealed the same relationships.

CONCLUSION

AGR is a promising biomarker in risk predictions for long-term mortality in diabetic individuals, particularly in those younger than 60 years and heavy drinkers.

Relationship between serum albumin level and hospitalization duration following percutaneous coronary intervention for acute coronary syndrome

Low serum albumin levels increase coronary morbidity, mortality, and postoperative cardiovascular risk. Therefore, this study investigated the relationship between these levels and the length of hospital stay in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome. A total of 350 patients were divided into quartiles according to serum albumin levels. Univariate and multivariate analyses were performed to identify factors associated with the length of hospital stay. A non-linear regression analysis of serum albumin and length of hospital stay was also performed. The results of the multifactorial analysis revealed low serum albumin levels as an independent predictor of longer hospital stay, even in the fully adjusted model. In the segmented linear regression model, serum albumin level showed a U-shaped relationship with the length of hospital stay. In conclusion, low serum albumin level was an independent predictor of longer hospital stay in patients undergoing PCI for acute coronary syndrome, with shorter stays observed for increasing serum albumin levels. Low serum albumin can be used to identify patients who require longer hospitalization and may need additional nutritional support or interventions to improve their prognosis.

Current Trends in Biohumoral Screening for the Risk of Sudden Cardiac Death: A Systematic Review

Background and Objectives: Sudden cardiac death (SCD) represents a challenge to health systems globally and is met with increased frequency in the population. Over time, multiple screening methods have been proposed, including the analysis of various plasma biomarkers. This article aims to analyze for illustrative purposes the specialized literature in terms of current biomarkers and testing trends, in the case of cardiovascular diseases and implicitly sudden cardiac death. Materials and Methods: In this regard, we searched the PubMed database from 2010 to the present time using the keywords "sudden cardiac death" and "biomarkers". The inclusion criteria were clinical trials that analyzed the effectiveness of screening methods in terms of biomarkers used in stratifying the risk of cardiac distress and/or sudden cardiac death. We excluded reviews, meta-analyses, and studies looking at the effectiveness of treatments. Results: An extended approach was found, through studies that brought to the forefront both classical markers analyzed by new, more performant methods, markers for other pathologies that also determined cardiovascular impact, non-specific molecules with effects on the cardiovascular system, and state-of-the-art markers, such as microRNA. Some molecules were analyzed simultaneously in certain groups of patients. Conclusion: The observed current trend revealed the tendency to define the clinical-biological particularities of the person to be screened.

The prognostic importance of the Naples prognostic score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

BACKGROUND

The Naples prognostic score (NPS) is an effective inflammatory and nutritional scoring system widely applied as a prognostic factor in various cancers. However, the prognostic significance of NPS is unknown in ST-segment elevation myocardial infarction (STEMI). We aimed to analyze the prognostic value of the NPS in-hospital mortality in patients with STEMI.

METHODS

The study consisted of 3828 patients diagnosed with STEMI who underwent primer percutaneous coronary intervention. As the primary outcome, in-hospital mortality was defined as all-cause deaths during hospitalization. The included patients were categorized into three groups based on NPS (group 1:NPS = 0,1,2; group 2:NPS = 3; group 3:NPS = 4).

RESULTS

Increased NPS was associated with higher in-hospital mortality rates( P  < 0.001). In the multivariable logistic regression analysis, the relationship between NPS and in-hospital mortality continued after adjustment for age, male sex, diabetes, hypertension, Killip score, SBP, heart rate, left ventricular ejection fraction, myocardial infarction type and postprocedural no-reflow. A strong positive association was found between in-hospital mortality and NPS by multivariable logistic regression analysis [NPS 0-1-2 as a reference, OR = 1.73 (95% CI, 1.04-2.90) for NPS 3, OR = 2.83 (95% CI, 1.76-4.54) for NPS 4].

CONCLUSION

The present study demonstrates that the NPS could independently predict in-hospital mortality in STEMI. Prospective studies will be necessary to confirm the performance, clinical applicability and practicality of the NPS for in-hospital mortality in STEMI.

The prognostic value of HALP score in predicting in-hospital mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

INTRODUCTION AND OBJECTIVE

Despite major advances in reperfusion therapies, morbidity and mortality rates associated with cardiovascular disorders remain high, particularly in patients with ST-segment elevation myocardial infarction (STEMI). Therefore, identifying prognostic variables that can be used to predict morbidity and mortality in STEMI patients is critical for better disease management. The HALP (hemoglobin, albumin, lymphocyte, and platelet) score, a novel index indicating nutritional status and systemic inflammation, provides information about prognosis. In this context, this study was carried out to investigate the relationship between HALP score assessed at admission and in-hospital mortality in STEMI patients.

MATERIAL AND METHODS

The population of this retrospective study consisted of 1307 consecutive patients diagnosed with STEMI and who underwent primary percutaneous coronary intervention (pPCI). The 1090 patients included in the study sample were divided into two groups based on the median HALP score value of 3.59. In-hospital and all-cause mortality rates during the follow-up were obtained from the registry.

RESULTS

In-hospital mortality rate was significantly higher in patients with a HALP score of less than 3.59 compared to those with a HALP score of more than 3.59 (7.5% and 0.7%, respectively; P < 0.001). Univariate and multivariate Cox proportional hazard analyses revealed that the HALP score is independently associated with in-hospital mortality. The optimal HALP score cutoff value of <3.72 predicted in-hospital mortality with 95.56% sensitivity and 49.19% specificity.

CONCLUSION

This study's findings indicate that HALP score may be a significant independent predictor of in-hospital mortality in patients with STEMI treated with pPCI.

A new marker for the prediction of contrast induced-acute kidney injury following primary percutaneous coronary intervention: logarithm of haemoglobin-albumin product

BACKGROUND

Contrast-induced acute kidney injury (CI-AKI) is a disorder that adversely affects the prognosis of STEMI. The study aimed to assess the predictive value of a new marker, logarithm of haemoglobin and albumin product (LHAP) on the risk of CI-AKI development after primary percutaneous coronary intervention (p-pcı).

METHOD

We retrospectively enrolled 3057 patients with ST-elevation acute myocardial infarction who were treated with p-PCI. The primary outcome was CI-AKI, defined as >25% or >0.5 mg/dl increase of baseline creatinine values during post-procedural 48 h.

RESULTS

First, a baseline model was produced to determine the predictors of CI-AKI, then haemoglobin, albumin and LHAP were included in the base model and the performances of all models were compared. The predictive accuracy (Likelihood ratio χ2 and R2) and discrimination (ROC-AUC) of the model including LHAP were significantly higher than that of models including both albumin and Hgb. LHAP best cut-off value for the development of CI-AKI was 9.26 (sensitivity 68% and specificity 66%).

CONCLUSION

LHAP values were the most important predictor of CI-AKI, followed by creatinine value and Killip class. LHAP values are significantly associated with CI-AKI after p-PCI.

Establishment and validation of a clinical nomogram model based on serum YKL-40 to predict major adverse cardiovascular events during hospitalization in patients with acute ST-segment elevation myocardial infarction

Objective

This study aimed to investigate the predictive value of a clinical nomogram model based on serum YKL-40 for major adverse cardiovascular events (MACE) during hospitalization in patients with acute ST-segment elevation myocardial infarction (STEMI).

Methods

In this study, 295 STEMI patients from October 2020 to March 2023 in the Second People's Hospital of Hefei were randomly divided into a training group (n = 206) and a validation group (n = 89). Machine learning random forest model was used to select important variables and multivariate logistic regression was included to analyze the influencing factors of in-hospital MACE in STEMI patients; a nomogram model was constructed and the discrimination, calibration, and clinical effectiveness of the model were verified.

Results

According to the results of random forest and multivariate analysis, we identified serum YKL-40, albumin, blood glucose, hemoglobin, LVEF, and uric acid as independent predictors of in-hospital MACE in STEMI patients. Using the above parameters to establish a nomogram, the model C-index was 0.843 (95% CI: 0.79-0.897) in the training group; the model C-index was 0.863 (95% CI: 0.789-0.936) in the validation group, with good predictive power; the AUC (0.843) in the training group was greater than the TIMI risk score (0.648), p < 0.05; and the AUC (0.863) in the validation group was greater than the TIMI risk score (0.795). The calibration curve showed good predictive values and observed values of the nomogram; the DCA results showed that the graph had a high clinical application value.

Conclusion

In conclusion, we constructed and validated a nomogram based on serum YKL-40 to predict the risk of in-hospital MACE in STEMI patients. This model can provide a scientific reference for predicting the occurrence of in-hospital MACE and improving the prognosis of STEMI patients.

Red Cell Distribution Width/Albumin Ratio: A Predictor of In-Hospital All-Cause Mortality in Patients with Acute Myocardial Infarction in the ICU

Purpose

Red cell distribution width (RDW) and albumin level are linked to adverse outcomes in patients with acute myocardial infarction (AMI). Nonetheless, it remains unknown whether the RDW/albumin ratio (RAR) is associated with the short-term prognosis of AMI. Using a large cohort, we aimed to explore the association between RAR and in-hospital all-cause mortality in intensive care unit (ICU) patients with AMI.

Patients and Methods

The patients' data analyzed in this retrospective cohort investigation were obtained from the eICU Collaborative Research Data Resource. RAR was calculated based on the serum albumin level and RDW. The primary outcome was in-hospital all-cause mortality. Receiver operating characteristic curve, multiple logistic regression model, and Kaplan-Meier survival analysis were performed to explore the prognostic value of RAR.

Results

We enrolled 2594 patients in this study. After correcting for confounding factors, the RAR was an independent predictor for in-hospital mortality in our model (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.12, 1.43). A similar relationship was observed with mechanical ventilation use. RAR showed a better predictive value with an area under the curve (AUC) of 0.738 (cutoff, 4.776) for in-hospital all-cause mortality compared to RDW or albumin alone. Kaplan-Meier estimator curve analyses for RAR demonstrated that the group with RAR ≥4.776%/g/dL had poorer survival than the group with RAR <4.776%/g/dL (p< 0.0001). The subgroup analysis revealed no significant interaction between RAR and in-hospital all-cause mortality in all strata.

Conclusion

RAR was an independent risk factor for in-hospital all-cause mortality in ICU patients with AMI. Higher RAR values corresponded to higher mortality rates. RAR is a more accurate predictor of in-hospital all-cause mortality in patients with AMI in the ICU than albumin or RDW. Thus, RAR may be a potential biomarker of AMI.

J-shaped association between serum albumin levels and long-term mortality of cardiovascular disease: Experience in National Health and Nutrition Examination Survey (2011-2014)

BACKGROUND

Cardiovascular disease (CVD) is a constellation of heart, brain, and peripheral vascular diseases with common soil hypothesis of etiology, and its subtypes have been well-established in terms of the albumin-mortality association. However, the association between albumin and the mortality of CVD as a whole remains poorly understood, especially the non-linear association. We aimed to investigate the association of albumin levels with long-term mortality of CVD as a whole.

MATERIALS AND METHODS

This study included all CVD patients who participated in the National Health and Nutrition Examination Survey (NHANES 2011-2014). CVD was defined as coronary heart disease, stroke, heart failure, or any combination of these two or three diseases. Serum albumin was tertile partitioned: tertile 1, <4.1; tertile 2, 4.1-4.3; and tertile 3, >4.3 g/dl. COX proportional hazards model was used to assess the association between the serum albumin levels and CVD mortality. Restricted cubic spline (RCS) curves were used to explore the non-linear relationship.

RESULTS

A total of 1,070 patients with CVD were included in the analysis, of which 156 deaths occurred during a median 34 months of follow-up. On a continuous scale, per 1 g/dl albumin decrease was associated with an adjusted HR (95% CI) of 3.85 (2.38-6.25). On a categorical scale, as compared with tertile 3, the multivariable adjusted hazard ratio (95% CI) was 1.42 (0.74-2.71) for the tertile 2, and 2.24 (1.20-4.16) for the tertile 1, respectively, with respect to mortality. RCS curve analysis revealed a J-shaped association between albumin and CVD mortality.

CONCLUSION

A J-shaped association between low serum albumin levels and increased long-term mortality of CVD has been revealed. This J-shaped association's implications for CVD prevention and treatment are deserving of being further studied.

High-Sensitivity C-Reactive Protein-to-Albumin Ratio in Predicting the Major Adverse Cardiovascular Event in Acute Coronary Syndrome at Presentation

Objective:

Our study aimed to determine the association between high sensitivity-c reactive protein to albumin ratio (CAR) and in-hospital major adverse cardiovascular event (MACE) in patients with acute coronary syndrome and also to assess whether hs-CAR is a better marker than hsCRP or albumin alone in predicting MACE.

Materials and Methods:

We enrolled 110 cases who were hospitalized and major adverse cardiovascular event was defined as cardiogenic shock, acute heart failure, reinfarction and death. Blood sample for Serum albumin and hs-crp was taken at the time when patients were admitted.

Results:

The incidence of MACE was more in patients with high CAR (≥1.8 group) as compared to those with low CAR (<1.8 group).

Conclusion:

The CAR is an independent predictor of MACE in patients who present with ACS.

Low serum albumin: A neglected predictor in patients with cardiovascular disease

Albumin, the most abundant circulating protein in blood, is an essential protein which binds and transports various drugs and substances, maintains the oncotic pressure of blood and influences the physiological function of the circulatory system. Albumin also has anti-inflammatory, antioxidant, and antithrombotic properties. Evidence supports albumin's role as a strong predictor of cardiovascular (CV) risk in several patient groups. Its protective role extends to those with coronary artery disease, heart failure, hypertension, atrial fibrillation, peripheral artery disease or ischemic stroke, as well as those undergoing revascularization procedures or with aortic stenosis undergoing transcatheter aortic valve replacement, and patients with congenital heart disease and/or endocarditis. Hypoalbuminemia is a strong prognosticator of increased all-cause and CV mortality according to several cohort studies and meta-analyses in hospitalized and non-hospitalized patients with or without comorbidities. Normalization of albumin levels before discharge lowers mortality risk, compared with hypoalbuminemia before discharge. Modified forms of albumin, such as ischemia modified albumin, also has prognostic value in patients with coronary or peripheral artery disease. When albumin is combined with other risk factors, such as uric acid or C-reactive protein, the prognostic value is enhanced. Although albumin supplementation may be a plausible approach, its efficacy has not been established and in patients with hypoalbuminemia, priority is focused on diagnosing and managing the underlying condition. The CV effects of hypoalbuminemia and relevant issues are considered in this review. Large cohort studies and meta-analyses are tabulated and the physiologic effects of albumin and the deleterious effects of low albumin are pictorially illustrated.

Mercaptoalbumin Is Associated with Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting

Coronary artery bypass graft (CABG) surgery still represents the gold standard for patients with complex multivessel coronary artery disease. However, graft occlusion still occurs in a significant proportion of CABG conduits, and oxidative stress is currently considered to be a potential contributor. Human serum albumin (HSA) represents the main antioxidant in plasma through its reduced amino acid Cys34, which can efficiently scavenge several oxidants. In a nested case–control study including 36 patients with occluded grafts and 38 age- and sex-matched patients without occlusion, we assessed the levels of the native mercaptoalbumin (HSA-SH) and oxidized thiolated form of albumin (Thio-HSA) in relation with graft occlusion within 5 years after CABG. We found that the plasma level of preoperative HSA-SH was significantly lower in patients with occluded graft at 5 years follow-up than in patients with graft patency. Furthermore, low HSA-SH remained independently associated with graft occlusion even after adjusting for preoperative D-dimer, a well-known marker of activated coagulation recently found to be associated with graft occlusion. In conclusion, the preoperative level of HSA-SH is independently associated with graft occlusion in CABG and represents a measurable and potentially druggable predictor.

A New Predictor of Mortality in ST-Elevation Myocardial Infarction: The Uric Acid Albumin Ratio

Several studies have shown that high uric acid (UA) and low serum albumin (SA) values increase the risk of cardiovascular disease and mortality in ST-elevation myocardial infarction (STEMI). We determined whether the uric acid/albumin ratio (UAR) is a predictor of mortality in STEMI patients. All patients who presented at our center with a diagnosis of STEMI and underwent percutaneous intervention from 2015 to 2020 were screened consecutively; 4599 patients were included. A Cox proportional hazards model was used to evaluate UAR, and adjusted predictors obtained from laboratory findings and clinical characteristics contributed to mortality. Also, a regression model was presented with a directed acyclic graph (DAG). The median age of the patients was 58 years (IQR [interquartile range]: 50–67); 3581 patients (77.9%) were male. The incidence of mortality in the entire patient group was 11.9%. Median follow-up duration of all groups was 42 months. Multivariate Cox proportional regression (model-1) analysis showed age (increase 50 to 67 years; HR [hazard ratio]: 1.34, 95% CI 1.18–1.52) and UAR (increase 1.15–1.73; HR: 1.33, 95% CI 1.16–1.52) were associated with mortality. UAR may be a prognostic factor for mortality in STEMI patients and an easily accessible parameter to identify high-risk patients.

Association of thrombocytopenia and infection in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention

Background

The impact of thrombocytopenia on infection in patients with ST-elevation myocardial infarction (STEMI) remains poorly understood.

Aims

To evaluate the association between thrombocytopenia and infection in patients with STEMI.

Methods

Patients diagnosed with STEMI were identified from January 2010 to June 2016. The primary endpoint was in-hospital infection, and major adverse clinical events (MACE) and all-cause death were considered as secondary endpoints.

Results

A total of 1401 STEMI patients were enrolled and divided into two groups according to the presence (n = 186) or absence (n = 1215) of thrombocytopenia. The prevalence of in-hospital infection was significantly higher in the thrombocytopenic group (30.6% (57/186) vs. 16.2% (197/1215), p < 0.001). Prevalence of in-hospital MACE (30.1% (56/186) vs. 16.4% (199/1215), p < 0.001) and all-cause death (8.1% (15/186) vs. 3.8% (46/1215), p = 0.008) revealed an increasing trend. Multivariate analysis indicated that thrombocytopenia was independently associated with increased in-hospital infection (OR, 2.09; 95%CI 1.32–3.27; p = 0.001) and MACE (1.92; 1.27–2.87; p = 0.002), but not all-cause death (1.87; 0.88–3.78; p = 0.091). After a median follow-up of 2.85 years, thrombocytopenia was not associated with all-cause death at multivariable analysis (adjusted hazard ratio, 1.19; 95%CI 0.80–1.77; p = 0.383).

Conclusions

Thrombocytopenia is significantly correlated with in-hospital infection and MACE, and might be used as a prognostic tool in patients with STEMI.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02210-3.

Ten-Year Mortality in Patients With ST-Elevation Myocardial Infarction

Knowledge of the long-term prognosis (>10 years) and mortality predictors of ST-elevation myocardial infarction (STEMI) patients who have undergone primary percutaneous coronary intervention (p-PCI) is scarce. Therefore, this study evaluated the long-term prognosis and determined the predictors of long-term outcomes for STEMI patients after p-PCI. Between January, 2006 and December, 2010, we collected data and analyzed 459 consecutive patients with acute STEMI who underwent p-PCI and were discharged from the hospital (mean age, 66.8 years; male, 75.2%; peak creatine phosphokinase level, 2,292.5 IU/L). The primary endpoint was 10-year all-cause mortality. The cumulative 10-year incidence of all-cause death was 23.8%. The Cox multivariate regression analysis identified age ≥ 65 years (adjusted hazard ratio [aHR], p <0.001), body mass index (aHR, 0.93, p = 0.033), presence of atrial fibrillation (aHR, 1.69, p = 0.038), mineralocorticoid receptor antagonist use (aHR, 1.95, p = 0.008), ejection fraction <40% (aHR, 2.14, p = 0.005), and albumin <3.5 g/dL (aHR, 2.01, p = 0.005) as independent predictors of all-cause mortality. In conclusion, a post-discharge 10-year survival rate of 76.2% was identified for STEMI patients who underwent p-PCI.

Serum albumin level for prediction of all-cause mortality in acute coronary syndrome patients: a meta-analysis

The prognostic utility of serum albumin level as a predictor of survival in patients with acute coronary syndrome (ACS) has attracted considerable attention. This meta-analysis sought to investigate the prognostic value of serum albumin level for predicting all-cause mortality in ACS patients. A systematic literature search was conducted in Pubmed and Embase databases until 5 March 2019. Epidemiological studies investigating the association between serum albumin level and all-cause mortality risk in ACS patients were included. Eight studies comprising 21667 ACS patients were included. Meta-analysis indicated that ACS patients with low serum albumin level had an increased risk of all-cause mortality (risk ratio [RR] 2.15; 95% confidence interval [CI] 1.68-2.75) after adjusting for important covariates. Subgroup analysis showed that the impact of low serum albumin level was stronger in hospital mortality (RR 3.09; 95% CI 1.70-5.61) than long-term all-cause mortality (RR 1.75; 95% CI 1.54-1.98). This meta-analysis demonstrates that low serum albumin level is a powerful predictor of all-cause mortality in ACS patients, even after adjusting usual confounding factors. However, there is lack of clinical trials to demonstrate that correcting serum albumin level by means of intravenous infusion reduces the excess risk of death in ACS patients.

Association Between Albumin Level and Mortality Among Cardiac Intensive Care Unit Patients

PURPOSE

To study the effect of hypoalbuminemia on short- and long-term mortality in Cardiac Intensive Care Unit (CICU) patients.

METHODS

We reviewed 12,418 unique CICU patients from 2007 to 2018. Hypoalbuminemia was defined as an admission albumin level <3.5 g/dL. Predictors of hospital mortality were identified using multivariable logistic regression.

RESULTS

We included 2,680 patients (22%) with a measured admission albumin level. The median age was 68 (39% females). Admission diagnoses included acute coronary syndrome, heart failure, cardiac arrest, and cardiogenic shock. The median albumin level was 3.4 g/dL and 55% of patients had hypoalbuminemia. Hospital mortality occurred in 16%, and patients with hypoalbuminemia had higher hospital mortality (21% vs. 9%, adjusted OR 2.64, 95% CI 2.09-3.34, p < 0.001). Albumin level was inversely associated with hospital mortality (adjusted OR 0.60 per 1 g/dL higher albumin level, 95% CI 0.47-0.75, p <0.001), with a stepwise increase in the hospital mortality at lower albumin levels. Post-discharge mortality was higher in hospital survivors with hypoalbuminemia, and increased as a function of lower albumin levels.

CONCLUSION

Hypoalbuminemia is common in CICU patients and associated with higher short- and long-term mortality. Progressively lower serum albumin was incrementally associated with higher hospital and post-discharge mortality.

Impact of Geriatric Nutritional Index in Contrast-Induced Nephropathy Developed in Patients with Non-ST Segment Elevation Myocardial Infarction who Underwent Percutaneous Coronary Intervention

Objective:

Geriatric nutritional risk index (GNRI) is a useful tool to determine the nutritional status of patients. Any study has not evaluated the impact of GNRI in development of contrast- induced nephropathy (CIN) after percutaneous coronary intervention (PCI). We aimed to evaluate whether GNRI could predict CIN after PCI.

Method:

A total of 1116 patients with non-ST elevation myocardial infarction (non-STEMI) that underwent PCI were enrolled to the present study. The GNRI was calculated using a previously reported formula: GNRI=14.89 × albumin (g/dL) + 41.7 × body weight (kg)/ideal body weight (kg). CIN was defined as an increase in serum creatinine level of ≥0.5 mg/dL or ≥25% above baseline within 72 hours after the PCI procedure. The patients were categorized into two groups as CIN (+) and CIN (-).

Results:

The mean age of the CIN (+) group was significantly higher than the CIN (–) group (64.8±10.67 vs. 60.5±10.61 years; p<0.001). The mean values of height, weight, and body mass index were significanlty lower in CIN (+) group than CIN (-) group (p<0.001, for all). The mean of GNRI was significantly lower in the CIN (+) group than the CIN (-) group (101.4±8.7 vs. 112.1±12.9; p<0.001). Serum albumin level was significantly lower in the CIN (+) group (3.71±0.52 g/dL vs. 3.94±0.53 g/dL; p<0.001). Left ventricular ejection fraction (LVEF) was significantly lower in the CIN (+) group (50.7%±9.07 vs. 54.3%±7.20; p<0.001).

Conclusion:

In this study, GNRI, serum albumin level, BMI, and LVEF were independent predictors of CIN. Moreover, GNRI was better than both serum albumin level and BMI in predicting development of CIN.

Prognostic Significance of Serum Albumin in Patients With Acute Coronary Syndrome

In patients with unstable angina pectoris (UAP) or non-ST elevation myocardial infarction (NSTEMI), long-term mortality remains high despite improvements in the diagnosis and treatment. In this study, we investigated whether serum albumin level is a useful predictor of long-term mortality in patients with UAP/NSTEMI. Consecutive patients (n = 403) who were hospitalized with a diagnosis of UAP/NSTEMI were included in the study. Patients were divided into 2 groups based on the presence of hypoalbuminemia and the relationship between hypoalbuminemia and mortality was analyzed. Hypoalbuminemia was detected in 34% of the patients. The median follow-up period was 35 months (up to 45 months). Long-term mortality rate was 32% in the hypoalbuminemia group and 8.6% in the group with normal serum albumin levels ( P < .001). On multivariate analysis, hypoalbuminemia, decreased left ventricular ejection fraction, and increased age were found to be independent predictors of mortality ( P < .05). The cutoff value of 3.10 g/dL for serum albumin predicted mortality with a sensitivity of 74% and specificity of 67% (receiver-operating characteristic area under curve: 0.753, 95% CI: 0.685-0.822). All-cause long-term mortality rates were significantly increased in patients with hypoalbuminemia. On-admission albumin level was an independent predictor of mortality in patients with UAP/NSTEMI.

Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome

Aim: The present study aimed to examine the correlation between high-sensitivity CRP to albumin ratio (CAR) and in-hospital and short-term major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). Materials & methods: We analyzed 652 consecutive patients who had been hospitalized for ACS. The MACEs were defined as cardiogenic shock, reinfarction, acute heart failure and all-cause death. Results: The incidence rate of MACEs was significantly higher in the high CAR (≥0.114) group than in the low CAR (<0.114) group. Multivariate analysis revealed that CAR, hs-CRP and albumin were independent predictors for increased risk for MACEs. Conclusion: The CAR was independently correlated with in-hospital and short-term MACEs and can be used for risk stratification in patients with ACS.

Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock

INTRODUCTION

The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown.

MATERIALS AND METHODS

P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. The primary outcome was all-cause 90-day mortality.

RESULTS

Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75%) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48% vs. 23%, p = 0.004). Odds ratio for death at 90 days was 2.4 [95% CI 1.5-4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95% CI 1.1-3.8], IABP-SHOCK II score adjusted odds ratio 2.5 [95%CI 1.2-5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95%CI 1.2-7.1]). In serial measurements, albumin levels decreased at a similar rate between 0h and 72h in both survivors and nonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p<0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome.

CONCLUSIONS

Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock.

TRIAL REGISTRATION

NCT01374867 at ClinicalTrials.gov.

The Ratio of Fibrinogen to Albumin as a Predictor of Contrast-Induced Nephropathy After Carotid Angiography

Contrast-induced nephropathy (CIN) is acute kidney failure that occurs after exposure to contrast agent. There is no sensitive biomarker to predict the development of CIN. In a retrospective study, we investigated the predictive value of the fibrinogen to albumin ratio (FAR) to determine the risk of CIN in patients (N = 246) who underwent carotid angiography. Contrast-induced nephropathy was defined as a 0.5 mg/dL or 25% increase in serum creatinine levels 48 to 72 hours following exposure to a radiocontrast agent. Patients were grouped according to whether they developed CIN or not, that is, CIN(-) and CIN(+) groups, respectively. Contrast-induced nephropathy developed in 39 (15.8%) of all the patients. The fibrinogen levels, neutrophil to lymphocyte ratio (NLR), and FAR in the CIN (+) group were higher than in the CIN (-) group ( P < .001). Multivariate analysis showed that age, diabetes, NLR, platelet-lymphocyte ratio, and FAR were independent risk factors for CIN. The area under the curve (AUC) of FAR was 0.800 for the prediction of CIN, and the best cutoff value was 57.4 with sensitivity, specificity, positive predictive value, and negative predictive value of 74.4%, 60.8%, 26.4%, and 92.7%, respectively. The FAR may be useful as a predictor of CIN.

Low serum prealbumin levels on admission can independently predict in-hospital adverse cardiac events in patients with acute coronary syndrome

The aim of this study is to evaluate if low prealbumin levels on admission predict subsequent adverse cardiac events in patients hospitalized with acute coronary syndrome (ACS).We designed a cohort study and enrolled 610 consecutive patients with ACS from whom venous blood for serum prealbumin measurement was drawn immediately upon hospital admission. Patients were classified in two groups according to prealbumin level: "normal" prealbumin levels (≥17 mg/dL, n=413) and "low" prealbumin (<17 mg/dL, n = 197). In-hospital adverse cardiac events were death, acute heart failure, reinfarction, and cardiogenic shock. Univariate and multivariable analyses were applied to evaluate the prediction value of low prealbumin.The incidence of in hospital adverse cardiac events is 10.8%. The proportion of adverse cardiac events was significantly higher in low prealbumin group as compared with normal prealbumin group (20.8% versus 6.1%, P < .001). Univariate analysis indicates that low prealbumin levels can predict in hospital adverse cardiac events (odds ratio [OR]: 0.834, 95% confidence interval [CI]: 0.785-0.886, P < .001). Multivariable analysis shows that low prealbumin level was an independent predictor for in hospital adverse cardiac events (adjusted OR: 0.918, 95% CI: 0.848-0.993, P = .033). Other independent predictors were lower in average hemoglobin level and Killip class II-IV on admission.Therefore, lower serum prealbumin levels on admission can independently predicts subsequent in hospital major adverse cardiac events in patients with ACS.

Albumin, a marker for post-operative myocardial damage in cardiac surgery

PURPOSE

Low serum albumin (SA) is a prognostic factor for poor outcome after cardiac surgery. The aim of this study was to estimate the association between pre-operative SA, early post-operative SA and postoperative myocardial injury.

METHODS

This single center cohort study included adult patients undergoing cardiac surgery during 4 consecutive years. Postoperative myocardial damage was defined by calculating the area under the curve (AUC) of troponin (Tn) values during the first 72 h after surgery and its association with SA analyzed using linear regression and with multivariable linear regression to account for patient related and procedural confounders. The association between SA and the secondary outcomes (peri-operative myocardial infarction [PMI], requiring ventilation >24 h, rhythm disturbances, 30-day mortality) was studied using (multivariable) log binomial regression analysis.

RESULTS

In total 2757 patients were included. The mean pre-operative SA was 29 ± 13 g/l and the mean post-operative SA was 26 ± 6 g/l. Post-operative SA levels (on average 26 min after surgery) were inversely associated with postoperative myocardial damage in both univariable analysis (regression coefficient - 0.019, 95%CI -0.022/-0.015, p < 0.005) and after adjustment for patient related and surgical confounders (regression coefficient - 0.014 [95% CI -0.020/-0.008], p < 0.0005).

CONCLUSIONS

Post-operative albumin levels were significantly correlated with the amount of postoperative myocardial damage in patients undergoing cardiac surgery independent of typical confounders.

Critical appraisal of the role of serum albumin in cardiovascular disease

Concentration of serum albumin (SA), a multifunctional circulatory protein, is influenced by several factors, including its synthesis rate, catabolism rate, extravascular distribution, and exogenous loss. Moreover, both nutritional status and systemic inflammation affect the synthesis of SA. Determining SA concentration aids in risk prediction in various clinical settings. It is of interest to understand the prognostic value of SA in the full spectrum of cardiovascular disease (CVD) in the era of newly developed pharmacological and interventional treatments. Proper interpretation of SA in addition to established risk factors potentially provides a better risk discrimination and thereby presents an option to modify therapeutic strategies accordingly. In this narrative review, we summarize the basic features of SA and its associated physiological functions contributing to its prognostic impacts on CVD. Finally, we discuss the prognostic role of SA in CVDs based on existing evidence.

Impact of serum albumin levels on long-term outcomes in patients undergoing percutaneous coronary intervention

Epidemiological studies have demonstrated an association between low serum albumin levels and both coronary artery disease (CAD) and mortality. However, the long-term clinical impact of low serum albumin level in patients with CAD undergoing percutaneous coronary intervention (PCI) has not yet been fully investigated. We studied 2860 all-comer patients with CAD who underwent their first PCI and had data available for pre-procedural serum albumin between 2000 and 2011. Patients were assigned to tertiles based on pre-procedural albumin levels. We evaluated the incidence of major adverse cardiac events (MACE), including all-cause death and nonfatal myocardial infarction. Mean albumin level was 4.0 ± 0.5 g/dL. Lower albumin levels were associated with older age, lower body mass index (BMI), and higher prevalences of female sex, ACS and chronic kidney disease (CKD). During the median follow-up period of 7.4 years, Kaplan-Meier curves showed ongoing divergence in rates of MACE among albumin tertiles (albumin <3.8 g/dl: 44.3% vs. 3.8-4.1 g/dl: 38.0% vs. >4.1 g/dl: 22.9%; log-rank p < 0.0001). After adjusting for established cardiovascular risk factors including age, acute coronary syndrome, BMI and CKD, serum albumin levels were significantly associated with incidence of MACE (HR 1.74 per 1-g/dl decrease, 95% CI 1.34-2.26, p < 0.0001) and all-cause mortality (HR 1.74, 95% CI 1.30-2.33, p = 0.0002). Pre-PCI low serum albumin level was associated with worse long-term outcomes, independent of traditional risk factors. Assessing albumin levels may allow risk stratification in patients with CAD undergoing PCI.

Association of Serum Prealbumin with Angiographic Severity in Patients with Acute Coronary Syndrome

Background

Serum prealbumin (PA), which is a nutritional index, has been found to be associated with severities and prognoses of various diseases. However, there are no reports about the relationship between PA and angiographic severity of coronary artery disease.

Material/Methods

This cross-sectional study included 867 patients with acute coronary syndrome (ACS) who underwent coronary angiography. Patients were divided into quartiles of PA and coronary artery stenosis was determined by angiographic Gensini score, the presence of high Gensini score (Gensini score ≥120), and triple-vessel disease. Multivariate linear and logistic regression analyses were performed to explore the relationship between PA and disease severity in a coronary angiogram.

Results

There was a significant and independent negative correlation between PA and Gensini score in multivariate linear regression (p=0.015). Logistic regression analysis revealed that crude odds ratios of triple-vessel disease and high Gensini score were 2.47 (95% CI: 1.66–3.67) and 1.83 (95% CI: 1.50–3.49), respectively, in the first quartile of PA compared with the fourth quartile and the results remained significant for high Gensini score after adjustment for confounding factors. In addition, estimated glomerular filtration rate, liver function, and high-sensitivity C-reactive protein (hs-CRP) had no interactive relationships in the above associations. Patients with lower levels of albumin or higher levels of hs-CRP or the ratio of hs-CRP to PA (hs-CRP/PA) also had more severe coronary atherosclerosis.

Conclusions

PA is negatively and independently associated with angiographic severity in patients with ACS, indicating for potential use in estimating the burden of coronary atherosclerosis.

Prognostic value of hypoalbuminemia for adverse outcomes in patients with rheumatic heart disease undergoing valve replacement surgery

High-risk patients with rheumatic heart disease (RHD) who were undergoing valve replacement surgery (VRS) were not identified entirely. This study included 1782 consecutive patients with RHD who were undergoing VRS to explore the relationship between hypoalbuminemia and adverse outcomes and to confirm whether hypoalbuminemia plays a role in risk evaluation. A total of 27.3% of the RHD patients had hypoalbuminemia. In-hospital deaths were significantly higher in the hypoalbuminemic group than in the non-hypoalbuminemic group (6.6% vs 3.1%, P = 0.001). Hypoalbuminemia was an independent predictor of in-hospital death (OR = 1.89, P = 0.014), even after adjusting for the Euro score. The addition of hypoalbuminemia to Euro score enhanced net reclassification improvement (0.346 for in-hospital death, P = 0.004; 0.306 for 1-year death, p = 0.005). A Kaplan-Meier curve analysis revealed that the cumulative rate of 1-year mortality after the operation was higher in patients with a new Euro score ≥6. These findings indicated that hypoalbuminemia was an independent risk factor for in-hospital and 1-year mortality after VRS in patients with RHD, which might have additive prognostic value to Euro score.

Association of low serum albumin concentration and adverse cardiovascular events in stable coronary heart disease

OBJECTIVE

Coronary heart disease (CHD) is a leading cause of death in developed countries. Exploration of indicators to identify high risk individuals who develop adverse outcomes despite stable baseline condition is important. This study is to evaluate the association between serum albumin concentration and cardiovascular (CV) outcomes in individuals of stable CHD.

METHODS

Seven-hundred-thirty-four participants from Biosignature study, a nationwide prospective cohort study aimed to identity risk factors among patients with stable CHD, were enrolled for analysis. They were divided into low serum albumin group (baseline albumin concentration <3.5g/dL, n=98) and normal albumin group (baseline albumin concentration ≥3.5g/dL, n=636). The relations between baseline albumin and adverse CV outcomes within 18months of follow-up were analyzed.

RESULTS

Compared baseline characteristics with normal albumin group, subjects in low albumin group are older, having more diabetic patients, lower hemoglobin level, lower estimated glomerular filtration rate, lower total cholesterol level, lower left ventricular ejection fraction, and higher blood glucose. While there is no significant difference of total CV events between two groups, low serum albumin concentration is associated with an increased risk of all-cause mortality (10.2% vs. 0.5%, p<0.001) and hard CV events (7.1% vs. 1.4%, p<0.001). The association remains significant after adjustments for confounders (all-cause mortality, HR: 6.81, 95% CI: 1.01-45.62; hard CV events, HR: 3.68, 95% CI: 1.03-13.19).

CONCLUSIONS

Low serum albumin concentration (<3.5g/dL) worsens prognosis of patients with stable CHD.

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

BACKGROUND

Decreased serum albumin level (SAL) was reported to be associated with increased risk of cardiovascular events and short term-mortality in patients with acute myocardial infarction (AMI).

OBJECTIVES

To evaluate the association between SAL and long-term mortality in AMI hospital survivors.

METHODS

Retrospective analysis of patients admitted in a tertiary medical center for AMI 2002-2012 and discharged alive.

EXCLUSION CRITERIA

active infections, inflammatory diseases, significant liver or kidney failure, malignancy, ejection-fraction <20%, severe heart valvular-disease and missing SAL. SAL was categorized as following: <3.4, 3.4-3.7, 3.7-3.9, 3.9-4.1 and >4.1g/dL. The primary outcome was all-cause mortality for up-to 10-years post-AMI.

RESULTS

Out of 12,535 patients, 8750 were included. Patients with reduced SAL were older, higher rate of women, increased prevalence of severe left ventricular dysfunction, chronic renal failure, diabetes mellitus and ST-elevation AMI, 3-vessel coronary artery disease, and in-hospital complications. While the prevalence of chronic ischemic coronary disease, dyslipidemia, smokers and obesity, was lower. Mortality rates throughout the follow-up period increased as SAL decreased with 17.6%, 24%, 28.5%, 38.6%, and 57.5% for SAL of >4.1, 3.9-4.1, 3.7-3.9, 3.4-3.7 and <3.4g/dL respectively (p-for-trend <0.001). Using the SAL category of >4.1g/dL as the reference group, Adjusted Hazard Ratio values were 1.14 (p=0.107), 1.23 (p=0.007), 1.39 (p<0.001) and 1.70 (p<0.001) for the SAL categories of 3.9-4.1, 3.7-3.9, 3.4-3.7 and <3.4g/dL respectively.

CONCLUSIONS

Decreased SAL on admission, including levels within "normal" clinical range, is significantly associated with long-term all-cause mortality in hospital survivors of AMI with a "dose-response" type association.

The relationship between fibrinogen to albumin ratio and severity of coronary artery disease in patients with STEMI

OBJECTIVE

Previous studies show that serum fibrinogen levels are established risk factors for coronary artery disease (CAD) and that serum albumin levels are of a higher specificity and sensitivity in ST-elevation myocardial infarction (STEMI). In this study, we sought to evaluate the association between fibrinogen to albumin ratio (FAR) and the extent and severity of CAD evaluated by TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries (SYNTAX) Score (SS) in patients with STEMI.

METHODS

A total of 278 patients with STEMI were included in the study. FAR was calculated using specified variables. The extent and severity of CAD were evaluated using the SS. The patients were divided into low- (SS <22) and high- (SS ≥22) risk groups. A Spearman rank correlation coefficient analysis was used for the relationship between FAR and SS. The cutoff points for sensitivity and specificity of FAR in predicting SS were estimated by performing a receiver operator characteristic curve analysis.

RESULTS

There were significant differences in the mean age (P=.016), admission serum albumin (P=.041), serum fibrinogen (P<.001), FAR (P<.001), and SS risk groups. Positive correlation was detected between FAR and SS (r=0.458, P<.001). A cutoff level of >87 FAR predicted SS (sensitivity, 70%; specificity, 70%), and an area under the curve of 0.758 serum fibrinogen and albumin level was an independent predictor for SS in patients with STEMI (b=0.039; 95% confidence interval, 0.016-0.062; P=.001 and b=-6.906; 95% confidence interval, -12.284 to -1.527; P=.013, respectively).

CONCLUSION

In the present study, we showed that FAR is significantly related to SS in predicting the severity of CAD in patients with STEMI.

Serum Albumin and Cerebro-cardiovascular Mortality During a 15-year Study in a Community-based Cohort in Tanushimaru, a Cohort of the Seven Countries Study

Objective There is little long-term data on the association between the serum albumin levels and mortality in community-based populations. We aimed to determine whether the serum albumin level is an independent risk factor for all-cause and cause-specific death in a community-based cohort study in Japan. Methods In 1999, we performed a periodic epidemiological survey over a 15-year period in a population of 1,905 healthy subjects (783 males, 1,122 females) who were older than 40 years of age and who resided in Tanushimaru, a rural community, in Japan. Over the course of the study, we periodically examined the blood chemistry of the study subjects, including their serum albumin levels. Their baseline serum albumin levels were categorized into quartiles. Results The baseline albumin levels were significantly associated with age (inversely), body mass index (BMI), diastolic blood pressure, lipid profiles [high density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c) and triglycerides] and estimated glomerular filtration rate (eGFR). After adjusting for confounders, a Cox proportional hazards regression analysis demonstrated that a low serum albumin level was an independent predictor of all-cause death [hazard ratio (HR): 0.39, 95% confidence interval (CI): 0.24-0.65], cancer death (HR: 0.43, 95% CI: 0.18-0.99), death from infection (HR: 0.21, 95% CI: 0.06-0.73) and cerebro-cardiovascular death (HR: 0.19, 95% CI: 0.06-0.63). The HRs for all-cause and cerebro-cardiovascular death in the highest quartile vs. the lowest quartile of albumin after adjusting for confounders were 0.59 (95%CI:0.39-0.88) and 0.15 (95%CI: 0.03-0.66), respectively. Conclusion The serum albumin level was thus found to be a predictor of all-cause and cerebro-cardiovascular death in a general population.

Usefulness of Serum Albumin Concentration to Predict High Coronary SYNTAX Score and In-Hospital Mortality in Patients With Acute Coronary Syndrome

High SYNTAX score is a predictor of adverse cardiovascular events, including mortality, in acute coronary syndromes (ACSs). Decreased serum albumin (SA) concentration is associated with an increased risk of cardiovascular events. We aimed to investigate whether SA levels at admission are associated with high SYNTAX score and in-hospital mortality in patients with ACS. The study included 1303 patients with ACS who underwent coronary angiography (CA). The patients were divided into 2 groups as high SYNTAX score (≥33) and lower SYNTAX score (≤32). Baseline SA levels were significantly lower in patients with high SYNTAX score than with lower SYNTAX score (3.46 ± 0.42 mg/dL vs 3.97±0.37 mg/dL, respectively; P < .001). On multivariate logistic regression, SA (<3.65 mg/dL) was an independent predictor of high SYNTAX score (odds ratio 4.329, 95% confidence interval 2.028-8.264; P < .001) together with admission glucose, estimated glomerular filtration rate, and left ventricular ejection fraction. In Cox regression analyses, systolic blood pressure, high SYNTAX score, and SA (<3.65 mg/dL) were found as independent predictors of in-hospital all-cause mortality. In conclusion, SA concentration on admission is inversely associated with high SYNTAX score and in-hospital mortality in ACS.

Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction

BACKGROUND

The optimal treatment strategies for acute ST-elevation myocardial infarction (STEMI) in older patients are unclear because of the high risk of mortality in this population. Hypoalbuminemia, frailty, and body mass index (BMI) have been reported to worsen the prognosis of some older patients with cardiovascular disease, but the specific impact of these factors on the prognosis after STEMI is poorly understood. The aim of this study was to investigate the impact of these factors on early outcomes in patients aged ≥85 years with acute STEMI.

METHODS

Sixty-two consecutive eligible patients aged ≥85 years (mean age, 88.1±2.5 years; age range, 85-94 years; female, 41.9%; primary percutaneous coronary intervention, 67.7%) who were admitted to our hospital with STEMI were retrospectively reviewed. Baseline patient characteristics, echocardiographic, electrocardiographic, and laboratory findings, and the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) score were assessed. The primary endpoint was in-hospital mortality and the secondary endpoint was failure of discharge to home. Independent baseline variables with a p-value of <0.15 in the univariate analyses were included in the multivariate analyses.

RESULTS

Multivariate analysis identified a higher baseline serum troponin I level [p=0.046; odds ratio (OR): 1.02], lower baseline albumin level (p=0.035, OR: 0.16), and CSHA-CFS score ≥6 (p=0.028, OR: 6.38) as independent predictors of in-hospital mortality. Lower BMI (p<0.001, OR: 0.49) and CSHA-CFS frailty score ≥6 (p=0.002, OR: 16.69) were identified as independent predictors of failure of discharge to home.

CONCLUSIONS

These findings indicate that the serum albumin level, CSHA-CFS score, and BMI, in addition to serum troponin I level, have an impact on the early prognosis of older patients with STEMI.

Impact of Serum Albumin Levels on Contrast-Induced Acute Kidney Injury in Patients With Acute Coronary Syndromes Treated With Percutaneous Coronary Intervention

Patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary intervention (PCI) are at high risk of contrast-induced acute kidney injury (CI-AKI), a complication associated with poor clinical outcomes. Serum albumin (SA) levels are associated with cardiovascular mortality. We assessed the association between SA levels and the risk of CI-AKI in patients with ACS (n = 890) treated with PCI. Patients were divided into 2 groups: patients with and without CI-AKI. Contrast-induced acute kidney injury was defined as an increase in serum creatinine (≥25% or ≥0.5 mg/dL) from baseline occurring 72 hours after PCI. The SA levels were significantly lower in patients with CI-AKI than in those without CI-AKI (3.52 ± 0.40 vs 3.94 ± 0.39 mg/dL, P < .001). On multivariate analysis, SA was an independent predictor of CI-AKI (odds ratio 0.177, 95% confidence interval 0.080-0.392, P < .001) together with age, female gender, creatine kinase-myocardial band, and glomerular filtration rate. Baseline SA levels are inversely associated with CI-AKI after PCI for ACS.

Serum albumin levels on admission are associated with angiographic no-reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Low serum albumin (SA) levels are associated with increased cardiovascular mortality. We investigated whether baseline SA levels are associated with no-reflow following primary percutaneous coronary intervention (pPCI). A total of 536 patients (aged 60 ± 13 years; 74% men) who underwent pPCI were enrolled. The patients were divided into 2 groups: no-reflow and normal-reflow. No-reflow was defined as thrombolysis in myocardial infarction ≤2 flow. Admission SA levels were significantly lower in the no-reflow group than in the normal-reflow group (3.55 ± 0.44 vs 4.01 ± 0.32 mg/dL, P < .001). Also, high-sensitivity C-reactive protein (hsCRP), creatinine, creatine kinase myocardial band isoenzyme, and troponin T were significantly higher while hemoglobin and left ventricular ejection fraction (LVEF) were significantly lower in the no-reflow group. In multivariate analysis, SA level remained an independent predictor of angiographic no-reflow (odds ratio 0.114, 95% confidence interval 0.032-0.405, P = .001) together with LVEF, hsCRP, and baseline culprit artery patency. Admission SA level was an independent predictor of no-reflow after pPCI.

Prevalence, clinical predictors, and prognostic impact of chronic renal insufficiency in very old Chinese patients with coronary artery disease

BACKGROUND AND AIMS

An aging population leads to the increased prevalence of coronary artery disease (CAD) and chronic renal insufficiency (CRI). Nevertheless, the prevalence, clinical predictors, and prognostic impact of CRI in very old Chinese patients with CAD are unclear.

METHODS

Baseline characteristics were obtained from 1,050 old patients with CAD. The endpoint was all-cause mortality during the mean follow-up period of 417 days.

RESULTS

The median age of the subjects was 86 years (range 60-104 years). CRI was present in 372 patients (35.4%). Age [hazard ratio (HR) 1.032, 95% confidence interval (95% CI) 1.010-1.054], chronic heart failure (CHF) (HR 2.361, 95% CI 1.747-3.191), hypertension (HR 1.878, 95% CI 1.291-2.731), hemoglobin (HR 0.973, 95% CI 0.965-0.981), serum albumin (HR 0.954, 95% CI 0.912-0.995), HDL-C (HR 0.371, 95% CI 0.238-0.580), and LDL-C levels (HR 0.795, 95% CI 0.656-0.965) were independent predictors of CRI (all P < 0.05). In addition, CRI was independently associated with mortality in patients with CAD (HR 1.366, 95% CI 1.024-1.822, P = 0.034). Age (HR 1.036, 95% CI 1.015-1.059), acute myocardial infarction (AMI; HR 1.795, 95% CI 1.239-2.602), CHF New York Heart Association class IV (HR 1.691, 95% CI 1.187-2.410), heart rate (HR 1.019, 95% CI 1.011-1.026), hemoglobin (HR 0.982, 95% CI 0.975-0.990), and serum albumin levels (HR 0.905, 95% CI 0.874-0.938) were also independently related to mortality in CAD patients (all P < 0.05).

CONCLUSIONS

A high prevalence of CRI with a high associated mortality rate existed in very old Chinese patients with CAD. CRI was an independent risk factor of adverse prognosis for these patients, and multiple predictors could be used to identify CAD patients at increased risk for CRI or poor survival.