Prognostic Significance of Serum Albumin in Patients With Acute Coronary Syndrome

Abstract

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.

Predictive Value of Serum Albumin in Patients With Acute Coronary Syndrome

“…Based on the study results, patients with SA level <3.5 g/dL were found to have a higher long-term mortality compared with those with SA level 3.5 g/dL. 1 Serum albumin is the most abundant protein of the extracellular vascular space, and it is a negative acute phase reactant marker of inflammation. 2 Until now, several studies have documented the prognostic value of SA in patients with stable coronary artery disease (CAD), ST elevation myocardial infarction, and pulmonary embolism.…”

“…Patients with the left anterior descending artery as the infarct-related artery usually have higher infarct area, thereby having low SA level. 1 However, multivessel involvement in such patients might be another possible confounding factor that should be clarified in the study. 1 Current European and North American guidelines recommend risk stratification of ACS cases using available risk scores, such as the thrombolysis in myocardial infarction (TIMI) score and the Global Registry of Acute Coronary Events (GRACE) score, to determine the in-hospital and 6-months risk of death and myocardial infarction in patients with ACS following an index event.…”

“…1 However, multivessel involvement in such patients might be another possible confounding factor that should be clarified in the study. 1 Current European and North American guidelines recommend risk stratification of ACS cases using available risk scores, such as the thrombolysis in myocardial infarction (TIMI) score and the Global Registry of Acute Coronary Events (GRACE) score, to determine the in-hospital and 6-months risk of death and myocardial infarction in patients with ACS following an index event. 5,6 Beside that, a recent study revealed that these scores had an adequate predictive power for long-term mortality in patients who were diagnosed and hospitalized with ACS.…”

“…We read with the interest the article entitled “Prognostic Significance of Serum Albumin in Patients With Acute Coronary Syndrome” by Polat et al 1 In this observational, retrospective study, the investigators evaluated the prognostic value of serum albumin (SA) in patients hospitalized with acute coronary syndrome (ACS). Based on the study results, patients with SA level <3.5 g/dL were found to have a higher long-term mortality compared with those with SA level ≥ 3.5 g/dL.…”

Reply to the Letter to the Editor Entitled “Predictive Value of Serum Albumin in Patients With Acute Coronary Syndrome”

“…We thank Cinar et al 1 for their interest in our study. 2 They suggested providing more detailed information on the enrolled patients regarding history of coronary artery disease (CAD). However, we consider that doing that is not needed.…”