Correlation between low serum albumin and major adverse cardiovascular events in patients with stable coronary heart disease / 中国医师进修杂志

ABSTRACT

Objective@#To investigate the correlation between low serum albumin level and major adverse cardiovascular events in patients with stable coronary heart disease.@*Methods@#A total of 367 consecutive patients with stable coronary heart disease from April 2013 to April 2015 in the Central Hospital of Nanchong City Sichuan Province were selected, and 328 cases completed follow-up. The follow-up time was (15.3 ± 8.1) months. The patients were divided into normal albumin group (serum albumin ≥ 35 g/L, 244 cases) and low serum albumin group (serum albumin < 35 g/L, 84 cases); then according to the happening of the major adverse cardiovascular events (MACE), the patients were divided into MACE group (53 cases) and non-MACE group (275 cases). The general clinical data were collected, including the gender, age, basic diseases (diabetes, hypertension), smoking history, body mass index (BMI), number of blood vessel lesion, drug treatment history. The serum albumin, hemoglobin, creatine, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triacylglycerol (TG), high sensitivity C reactive protein (hs-CRP) were detected. The estimated glomerular filtration rate (eGFR) was calculated by modification of diet in renal disease (MDRD) formula; the left ventricular ejection fraction (LVEF) was detected by color Doppler echocardiography. The Kaplan-Meier curve and receiver operating characteristics (ROC) curve were analyzed respectively, and the prognosis was analyzed by Cox regression.@*Results@#The age, diabetes rate, TG and hs-CRP in low serum albumin group were significantly higher than those in normal albumin group (66.99 ± 9.40) years vs. (61.65 ± 9.36) years, 46.43% (39/84) vs. 34.02% (83/244), (2.36 ± 0.10) mmol/L vs. (2.15 ± 0.05) mmol/L and (4.10 ± 0.35) g/L vs. (3.83 ± 0.39) g/L, the albumin, hemoglobin, LVEF and eGFR were significantly lower than those in normal albumin group (30.36 ± 3.09) g/L vs. (42.95 ± 4.86) g/L, (126.42 ± 18.45) g/L vs. (142.35 ± 16.53) g/L, (50.71 ± 5.60)% vs. (56.66 ± 8.01)% and (68.25 ± 12.47) ml/(min·1.73 m2) vs. (84.42 ± 14.48) ml/(min·1.73 m2), and there were statistical differences (P < 0.01 or <0.05); there were no statistical differences in gender composition, hypertension rate, smoking history, drug treatment history, BMI, number of blood vessel lesion, creatine, TC, LDL-C and HDL-C between 2 groups (P>0.05). The albumin in MACE group was significantly lower than that in non-MACE group (34.09 ± 6.87) g/L vs. (40.81 ± 6.90) g/L, the TG was significantly higher than that in non-MACE group (2.24 ± 0.11) mmol/L vs. (2.20 ± 0.11) mmol/L, and there were statistical differences (P<0.01); there were no statistical difference in gender composition, age, basic diseases, smoking history, drug treatment history, BMI, number of blood vessel lesion, hemoglobin, LVEF, eGFR, creatine, TC, LDL-C, HDL-C and hs-CRP between 2 groups (P>0.05). Cox regression analysis result showed that the hemoglobin, eGFR and albumin were the independent risk factors of MACE in patients with stable coronary heart disease (RR = 1.020, 1.040 and 0.787; 95% CI 1.001 to 1.040, 1.016 to 1.064 and 0.733 to 0.846; P < 0.05 or <0.01). Kaplan-Meier curve result showed that the lower the level of serum albumin, the higher the incidence of MACE in patients with stable coronary heart disease (log-rank χ2 = 6.244, P = 0.012). ROC curve analysis result showed that the cut-off value of serum albumin was 39.8 g/L, the area under curve was 0.769 (95% CI 0.719 to 0.813), with a sensitivity of 90.6%, a specificity of 60.4%.@*Conclusions@#There is close correlation between low serum albumin and recent MACE in patients with stable coronary heart disease, and it can be used as a index for the poor prognosis of patients.