C-reactive protein-to-serum albumin ratio as a novel predictor of long-term outcomes in coronary artery disease patients who have undergone percutaneous coronary intervention: analysis of a real-world retrospective cohort study

Abstract

Background C-reactive protein (CRP) has been proposed as a contributor to the pathogenesis of coronary artery disease (CAD) and inflammatory reactions, which are associated with a decrease in serum albumin, and it has been reported that the CRP-to-serum albumin ratio (CAR) can predict CAD severity in inpatient ischemic cardiomyopathy (ICM) patients. However, the relationship between the CAR and long-term adverse outcomes in CAD patients after percutaneous coronary intervention (PCI) is still unknown. Methods A total of 3561 CAD patients enrolled in the Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI: an investigation based on case records and follow-up (CORFCHD-ZZ), a retrospective cohort study conducted from January 2013 to December 2017, and 1630 patients meeting the study inclusion criteria were divided into two groups based on the CAR (CAR < 0.186; n = 1301 and CAR ≥ 0.186; n = 329). The primary outcome was long-term mortality, including all-cause mortality (ACM) and cardiac mortality. The average follow-up time was 37.59 months. Results We found that there were significant differences between the two groups in the incidences of ACM (P < 0.001) and cardiac mortality (P = 0.003). Cox multivariate regression analyses demonstrated that CAR was an independent predictor of ACM [hazard ratio, 2.678; (95% confidence interval (CI), 1.568–4.576); P < 0.001] and cardiac mortality (hazard ratio, 2.055; 95% CI, 1.056–3.998; P = 0.034) in CAD patients after PCI. Conclusion This study revealed that the CAR is an independent and novel predictor of long-term adverse outcomes in CAD patients who have undergone PCI.

Prognostic value of C-reactive protein to albumin ratio for long-term outcomes of patients with peripheral arterial disease underwent endovascular treatment

“…[29][30][31] Because inflammation is among the well-known underlying mechanisms of atherosclerosis, and CRP and albumin are well-defined inflammatory markers, the CRPto-albumin ratio may better indicate the inflammatory status of a patient. The prognostic value of CAR has been widely reported for various cardiovascular diseases [32][33][34] ; however, the current study is the first to report the role of CAR in the prediction of amputation and all-cause mortality in patients with PAD who have undergone endovascular treatment. The Kaplan-Meier curve showed a higher rate of amputationfree survival and a lower mortality rate in patients with low CAR levels.…”

The Association Between High-Sensitivity C-Reactive Protein/Albumin Ratio and Cardiovascular Prognosis in Patients Undergoing Percutaneous Coronary Intervention

“…After a mean follow-up of 34±15 months, the outcomes suggested that CAR was a potentially useful prognostic maker for predicting long-term all-cause death in STEMI patients. Liu et al 29 retrospectively enrolled 1630 CHD patients undergoing PCI. The primary endpoint included all-cause death and cardiac death, and the average follow-up period was 38 months.…”

High C-Reactive Protein/Low Serum Albumin: A Hidden Villain in Cardiovascular Disease

“…These results add to the recent literature supporting that CAR is a marker of inflammation status, associated with poor prognosis in patients with CV (and even non-CV) diseases. [2][3][4][5][6] Interestingly, even when baseline low-densitylipoprotein cholesterol (LDL-C) levels were well-controlled, the residual inflammation risk post-PCI remained high. 1 Further analysis showed that higher CAR was associated with older age, higher incidence of MI, more 3-vessel disease, adverse lipids, raised glucose and SYNTAX score, lower left ventricular ejection fraction, and reduced estimated glomerular filtration rate.…”

“…2,7 When albumin is combined with other risk factors, such as uric acid or CRP, the prognostic value is enhanced. 6,8 On the other hand, normalized albumin levels seem to lower mortality risk compared with hypoalbuminemia. 9 In a similar context, a retrospective study, also published in Angiology, showed that the serum albumin to serum creatinine (sACR) ratio was inversely associated with clinical outcomes in 3057 patients with ST-elevation MI after primary PCI.…”

“…2,7 When albumin is combined with other risk factors, such as uric acid or CRP, the prognostic value is enhanced. 6,8 On the other hand, normalized albumin levels seem to lower mortality risk compared with hypoalbuminemia. 9…”