Prognostic Implications of Serum Albumin Levels in Patients With Acute Coronary Syndromes.
Hypoalbuminemia is a long-term risk factor for incident of both myocardial infarction and heart failure. We assessed whether serum albumin levels at admission are associated with new-onset heart failure and in-hospital mortality in patients with acute coronary syndrome (ACS). The study included 7,192 patients with ACS with no previous history of heart failure. Patients were divided into quartiles according to serum albumin levels (Q1: ≤3.50 g/dl; Q2: 3.51 to 3.80 g/dl; Q3: 3.81 to 4.08 g/dl; and Q4: >4.08 g/dl). Logistic regressions were used to explore the relations among serum albumin quartiles, new-onset heart failure, and in-hospital mortality. Serum albumin levels were negatively correlated with both high-sensitivity C-reactive protein and white blood cell count at admission. The unadjusted rate for both new-onset heart failure (37.7%, 20.2%, 14.7%, and 11.4% for Q1, Q2, Q3, and Q4, respectively; p <0.0001) and in-hospital mortality (9.8%, 3.4%, 2.0%, and 1.7% for Q1, Q2, Q3, and Q4, respectively; p <0.0001) were higher at lower serum albumin levels. Multivariate analysis demonstrated that serum albumin level ≤3.50 g/dl is an important and independent predictor of both the development of new-onset heart failure (odds ratio 2.31, 95% CI 1.87 to 2.84, p <0.0001) and in-hospital mortality (odds ratio 1.88, 95% CI 1.23 to 2.86, p = 0.003). In conclusion, albumin level ≤3.50 g/dl is an independent predictor of new-onset heart failure and in-hospital mortality in patients with ACS. The inflammatory state may be a mechanism underlying hypoalbuminemia in this clinical setting.
Coronary Care Unit, National Institute of Cardiology in Mexico City, Mexico. Electronic address: hectorglezp@hotmail.com.
Héctor
H
González-Pacheco
Department of Immunology, National Institute of Cardiology in Mexico City, Mexico; Department of Health Care, Metropolitan Autonomous University, National Institute of Cardiology in Mexico City, Mexico.
Luis M
LM
Amezcua-Guerra
Division of Research, National Institute of Cardiology in Mexico City, Mexico.
Julio
J
Sandoval
Coronary Care Unit, National Institute of Cardiology in Mexico City, Mexico.
Carlos
C
Martínez-Sánchez
Coronary Care Unit, National Institute of Cardiology in Mexico City, Mexico.
Xochitl A
XA
Ortiz-León
Coronary Care Unit, National Institute of Cardiology in Mexico City, Mexico.
Marco A
MA
Peña-Cabral
Department of Immunology, National Institute of Cardiology in Mexico City, Mexico; Department of Health Care, Metropolitan Autonomous University, National Institute of Cardiology in Mexico City, Mexico.
Rafael
R
Bojalil
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*
D015415:Biomarkers; D012709:Serum Albumin; D002097:C-Reactive Protein