The Predictive Value Of The C-reactive Protein To Albumin Ratio On The Long-term Follow-up Outcomes In Coronary Artery Disease Patients Who Had Undergone Percutaneous Coronary Intervention

BackgroundAtherosclerosis is a gradual pathological progression characterized by lipid plaque deposition in the arterial intima,invasion of inflammatory cells,formation of foam cells and fibrous cap of smooth muscle extracellular matrix,etc.,which can gradually involve coronary arteries,aorta,and cerebral arteries.Coronary heart disease can lead to multiple cardiovascular adverse events,including acute myocardial infarction,severe arrhythmia,heart failure,and cardiogenic death.PCI(Percutaneous coronary intervention)is an effective treatment for patients with coronary heart disease,such as acute myocardial infarction or unstable angina,thus,early analysis of the long-term survival-prognosis of patients with coronary-heart disease after PCI was especially important.Recent studies have found that C-reactive proteins(CRP)not only can be used as a sensitive indicator of inflammation,but also can be used as a pathogenic factor to participate the atherosclerosis process of coronary arteries.The human serum albumin(ALB)is an acute phase reactional protein,its own concentration can be reduced in the inflammatory response,and it plays an important role in the regulation of platelet activation and aggregation.In recent years,the results of the studies showed that the CRP to ALB ratio,CAR,can predict the severity of coronary artery disease,but the prediction value of CAR in long-term survival prognosis in patients with coronary heart disease is also required further clinical tests.PurposeThis study will explore the predictive value of the CAR on the long-term outcomes in coronary artery disease patients who have undergone percutaneous coronary intervention.MethodsThis study included 3,561 patients who were hospitalized for the first time PCI in the First Affiliated Hospital of Zhengzhou University,from January 2013 to December 2017.The last follow-up date is June 2019 and the average follow-up period were 37.59±22.24 months.And it collected the patients’ demographic data,biochemical data and laboratory related data.After screening there are 1630 patients left.According to the CAR cutoff value,the patients were divided into two groups:the low CAR value(<0.186)group(n=1301)and the high CAR value(≥0.186)group(n=329).The primary outcomes of the study were the all-cause mortality(ACM),and the cardiogenic death(CM),the secondary outcomes were the major adverse cardiovascular event(MACE),the major adverse cardiovascular and cerebrovascular events(MACCE),bleeding events,rehospitalization events,and new diagnosed heart failure.In the meantime,the subgroups of the patients with the stability angina and the patients with acute coronary syndrome were analyzed.ResultsIn all patients,for the primary outcomes,the ACM(2.8%vs.7.9%,P<0.001)and CM(2.0%vs.4.9%,P=0.003)in the low CAR group were lower than those in the high CAR group.For the secondary outcomes,there was no significant difference in the incidences of MACE,MACCE,bleeding events,rehospitalization events,and new diagnosed heart failure during follow-up in the low and high CAR groups.In the subgroup of patients with stable angina pectoris,ACM(P=0.015)in the low CAR group were significantly lower than those in the high CAR group,not in CM(P=0.099);at the secondary outcomes,there are no significant differences(all P>0.05)in the two groups with MACE,MACCE,bleeding events,or readmission events.In the subgroup of patients with acute coronary syndrome,ACM and CM in the low CAR group was significantly lower than that in the high CAR group(P<0.001 and P=0.013);at the secondary outcomes,there were no significant differences in MACE,MACCE,bleeding events,readmissions,and heart failure events(all P>0.05)in the two groups.In the CAR univariate Cox regression analysis,the CAR was an independent predictor of ACM(HR=3.033,95%CI:1.830-5.024,P<0.001)and CM(HR=2.569,95%CI:1.377-4.791,P=0.003).In patients with stable angina pectoris,the CAR was an independent predictor of ACM(HR=5.135,95%CI:1.623-16.250,P=0.005).In patients with acute coronary syndrome,the CAR value at admission was correlated with ACM(HR=2.781,95%CI:1.585-4.879,P<0.001)and CM(HR=2.362,95%CI:1.182-4.720,P=0.015).Using multivariate Cox regression analysis,after adjusting for age,systolic blood,white blood cells,serum creatinine,HDL-c and other baseline confounding factors,the CAR was an independent predictor of ACM(HR=2.678,95%CI:1.568-4.576,P<0.001)and CM(HR=2.055,95%CI:1.056-3.998,P=0.034).And in the subgroup of patients with acute coronary syndrome,the CAR value was correlated with ACM(HR=2.343,95%CI:1.301-4.219,P=0.005).ConclusionThe CAR can be an independent prediction factor of the long-term mortality risk of patients with coronary heart disease patients after PCI,and it is likely to be a useful way to assess the risk of cardiovascular events in coronary heart disease patients,which may help identify high-risk patients to predict the occurrence of cardiovascular adverse events.CAR has a strong prediction value in patients with coronary heart disease and acute coronary syndrome.