The Association Of Serum Albumin With Acute Myocardial Infarction Incident And Its Long-term Mortality

Objective To evaluate the association of serum albumin(SA)with acute myocardial infarction(AMI)incident and long-term all-cause mortality in patients with AMI.Methods The study included two chapters: a cross-sectional study and a cohort study.First chapter:A total of 2172 with AMI patients served as an observation group and 3395 CHD-free patients served as a control group.The association between SA level and AMI was analyzed by using logistic regression analysis.Second chapter:The cohort study enrolled 2305 patients with AMI.The median follow-up was of 1088 days(3 years).Impacts of SA on long-time mortality after AMI were determined using multivariate Cox proportional hazard regression analysis with backward selection.Results First chapter:The SA level in observation group was significantly lower than that in control group [40.0(5.3)g/l vs 41.4(4.6)g/l,P=0.000].On a continuous scale,when SA level decreased by 1 standard deviation(~4g/l),adjusted OR(95% CI)was 1.87(1.75-2.01),1.85(1.71-2.01),1.48(1.26-1.74)for AMI in the total patients,male patients and female patients,respectively.On a categorical scale,the 1st albumin quintile(Q1,? 43.8g/l)was used as reference.Stratifying by age showed that adjusted OR(95%CI)was Q2 1.43(1.12-1.82),Q3 1.95(1.53-2.47),Q4 2.52(1.95-3.27),Q5 4.51(3.40-6.00)for AMI in patients aged < 65 years and was Q2 1.61(1.04-2.5),Q3 2.21(1.48-3.31),Q4 3.34(2.24-4.99),Q5 4.77(3.22-7.08)in patients aged ? 65 years(p-for-trend < 0.01).Stratifying by gender showed that adjusted odds ratio was Q2 1.47(1.18-1.85),Q3 2.05(1.64-2.56),Q4 3.01(2.38-3.79),Q5 5.51(4.32-7.04)for AMI in men and was Q2 2.03(1.18-3.48),Q3 2.24(1.34-3.75),Q4 2.75(1.63-4.65),Q5 4.37(2.56-7.49)in women(p-for-trend < 0.01).Second chapter:Among 2305 patients,1836(79.7%)were males.The median age was 65 years,and the median SA concentration was 39.2 g/l.SA levels ?36.2,36.3–40.8,> 40.8 g/l were defined as low,intermediate,and high tertile,respectively.Patients in low tertile were older and more likely to experience heart failure,kidney dysfunction,ischemic or hemorrhagic stroke,atrial fibrillation/flutter,anemia,and triple-vessel disease.Patients in high tertile were more likely to receive PCI during hospitalization and had higher levels of hyperlipidemia and a current smoking habit.During follow-up,a total of 262(11.4%)patients died.The unadjusted cumulative all-cause mortality after AMI were 10.0%,18.4% and 36.5% for the high,intermediate and low level group,respectively.Log-rank test showed that cumulative incidences of all-cause were significantly different among SA tertiles(P <0.001).The high-tertile group was used as reference.In univariate Cox modeling,hazard ratios(HRs)for all-cause death were 1.81(95%CI,1.22–2.67;P = 0.003)and 4.34(95%CI,3.07–6.15;P <0.001)for intermediate and low tertile,respectively(p-for-trend <0.001).In multivariate-adjusted Cox modeling,the adjusted HRs for all-cause death were 1.21(95% CI,0.82–1.8;P = 0.338)and 1.74(95% CI,1.21–2.52;P = 0.003)for intermediate and low tertile,respectively(p-for-trend = 0.001).Moreover,after adjustment for confounding variables,adjusted HRs per 10-g/l decrease in SA concentrations were 1.66(95% CI 1.24-2.22,P = 0.001)for all-cause death.Conclusions SA concentrations are negatively associated with the risk of AMI regardless of stratifying by age and/or gender.Low SA concentrations is an independent predictor of long-term all-cause mortality in patients with AMI.Whether the albumin transfusion for patients with hypoproteinemia will reduce the risk of AMI incident and improve AMI patients' outcome or not deserves further studies.