title: 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.
abstract: 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).
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Soroka University Medical Center and Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: Plakht@bgu.ac.il.
authors.forename: Ygal
authors.initials: Y
authors.lastname: Plakht
authors.affiliation: Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Harel
authors.initials: H
authors.lastname: Gilutz
authors.affiliation: Department of Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
authors.forename: Arthur
authors.initials: A
authors.lastname: Shiyovich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D010343:Patient Admission / Q000639:trends*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism*; D017741:Survivors; D062606:Tertiary Care Centers / Q000639:trends*
chemical_list: D015415:Biomarkers; D012709:Serum Albumin
keywords: Acute myocardial infarction; Hospital survival; Long-term prognosis; Serum albumin