Prognostic value of serum albumin-to-creatinine ratio in patients with acute myocardial infarction

Abstract

The long-term association between serum albumin-to-creatinine ratio (sACR) and poor patient outcomes in acute myocardial infarction (AMI) remains unclear. This study aimed to determine whether sACR was a predictor of poor long-term survival in patients with AMI. This was a study of patients with AMI in the emergency department (ED) from the retrospective multicenter study for early evaluation of acute chest pain (REACP) study. The patients were categorized into tertiles (T1, T2, and T3) based on the admission sACR (0.445 and 0.584 g/μmol). Baseline sACR at admission to the ED was predictive of adverse outcomes. The primary outcome was all-cause mortality within the follow-up period. Cox proportional hazards models were performed to investigate the association between sACR and all-cause mortality in patients with AMI. A total of 2250 patients with AMI were enrolled, of whom 229 (10.2%) died within the median follow-up period of 10.7 (7.2–14.6) months. Patients with a lower sACR had higher all-cause mortality and adverse outcomes rates than patients with a higher sACR. Kaplan–Meier survival analysis showed that patients with a higher sACR had a higher cumulative survival rate ( P < .001). Cox regression analysis showed that a decreased sACR was an independent predictor of all-cause mortality [T2 vs T1: hazard ratio (HR); 0.550, 95% confidence interval (95% CI), 0.348–0.867; P = .010 and T3 vs T1: HR, 0.305; 95% CI, 0.165–0.561; P < .001] and cardiac mortality (T2 vs T1: HR, 0.536; 95% CI, 0.332–0.866; P = .011 and T3 vs T1: HR, 0.309; 95% CI, 0.164–0.582, P < .001). The sACR at admission to ED was independently associated with adverse outcomes, indicating that baseline sACR was a useful biomarker to identify high-risk patients with AMI at an early phase in ED.

Serum Albumin to Creatinine Ratio and Short-Term Clinical Outcomes in Patients With ST-Elevation Myocardial Infarction

“…They found that patients with lower sACR had higher all-cause mortality and adverse events during a median follow-up of 10.7 months compared with patients with higher sACR. 28 They concluded that sACR improved the prognostic value of the GRACE score.…”

“…Moreover, lower levels of SA were also associated with cardiac and overall mortality. 28 A recent study (2250 patients with AMI) investigated sACR for the prediction of poor long-term survival in patients with AMI. 28 Other risk scores were also concomitantly evaluated.…”

“…28 A recent study (2250 patients with AMI) investigated sACR for the prediction of poor long-term survival in patients with AMI. 28 Other risk scores were also concomitantly evaluated. They found that patients with lower sACR had higher all-cause mortality and adverse events during a median follow-up of 10.7 months compared with patients with higher sACR.…”

“…These results may be attributed to the complex pathophysiology of ACS that includes thrombosis and inflammation. [28][29][30][31][32] Based on recent evidence regarding its antioxidant features, 29,31 SA protects cells against oxidative stress by binding and carrying some substances such as nitric oxide. In previous studies, it was demonstrated that SA also reacts in favor of anticoagulant and anti-aggregation activity.…”

Diagnostic and Prognostic Biomarkers for Myocardial Infarction

“…The urine albumin-to-creatinine ratio (uACR) has been verified to be independently associated with increased long-term risks of cardiovascular and total mortality in survivors of MI ( 28 ). The serum albumin-to-creatinine ratio (sACR) was found to be an independent prognostic biomarker in patients with AMI on admission to the emergency department and a useful biomarker for early risk stratification of patients with AMI ( 82 ).…”