Value Of Red Cell Distribution Width/Albumin Ratio On Predicting Long Term Mortality In Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

BackgroundAtherosclerosis,mainly affecting large and medium-sized arteries,is a pathological process characterized by damage of vascular endothelial cell structure and function,increasing permeability of vascular,deposition and peroxidation of blood lipids in the vascular wall,infiltration of inflammatory cells,release of inflammatory mediators and cytokines,migration and proliferation of smooth muscle cell,formation of foam cell and increased synthesis of extracellular matrix such as collagen fibers,elastic fibers,etc.Coronary artery disease(CAD)is the most common type of atherosclerosis,and its incidence is ever-increasing in resent years.The pathological process of atherosclerosis is very slow and often ignored because of no typical symptoms in the early period.Once it is in the late period,it is very serious,even life-threatening.Identification of risk factors and early intervention are important measures for prevent of coronary artery disease.Red blood cell distribution width(RDW),a simple and inexpensive parameter,reflect the heterogeneity of red blood cell volume,which is traditionally used to the diagnosis of differential anemia together with other laboratory parameters.Human serum albumin(ALB)is the most abundant protein in plasma which is synthesized in liver and plays a key role for maintaining a stable plasma colloid osmotic pressure and adequate nutritional balance.In recent years,some studies have shown that RDW and serum albumin level are predictors of morbidity and prognosis in patients with cardiovascular disease.It has also been reported that Red cell distribution width/albumin ratio(RAR),a new joint index,can predict the severity and prognosis of chronic hepatitis B-related liver cirrhosis,which is more accurate than RDW and albumin.However,the relation has not been evaluated between RDW/ALB ratio and the prognosis of patients with cardiovascular disease.PurposeTo investigate the relation between the baseline level of red cell distribution width/albumin ratio(RAR)and the long-term prognosis of patients with coronary artery disease(CAD)after percutaneous coronary intervention(PCI).MethodsA total of 3338 patients with CAD were included who received PCI treatment in the The First Affiliated Hospital of Zhengzhou University from January 2013 to December 2017.The study population was classified into 2547 patients with acute coronary syndrome and 791 patients with stable coronary heart disease.According to the RAR value,the patients were divided into two groups:RAR<0.33(n=1782)and RAR?0.33(n=1556).The main end point was long-term mortality,including all-cause mortality(ACM)and cardiac mortality(CM).The secondary end points included major adverse cardiac events(MACE)and major adverse cardiovascular and cerebrovascular events(MACCE).ResultsIn our study,mean follow-up time was 37.59 ± 22.24 months.Univariate Cox regression analysis showed that there were significant differences in long-term adverse outcomes between the two groups,such as ACM(HR=3.021,95%CI:2.047-4.459,P<0.001),CM(HR=3.392,95%CI:2.042-5.632,P<0.001)and MACE(HR=1.238,95%CI:1.011-1.515,P=0.039).After adjusting for confounders including sex,age,blood urea nitrogen,creatinine,uric acid,triglyceride,high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C),Multivariate Cox regression analysis revealed that RAR level was also associated with long-term adverse outcomes such as ACM(HR=2.111,95%CI:1.397-3.190,P<0.001),CM(HR=2.317,95%CI:1.360-3.950,P=0.002)and MACE(HR=1.257,95%CI:1.012-1.562,P=0.039)in all patients.Subgroup analysis showed that RAR was an important and independent predictor for ACM(HR=2.110,95%CI:1.385-3.214,P=0.001)and CM(HR=1.993,95%CI:1.097-3.622,P=0.024)in acute coronary syndrome patients.However,for stable coronary artery disease patients,we did not found significant differences in any adverse outcomes after adjusting for confounders.ConclusionThe RAR value at admission has certain value for long-term prognosis after PCI in patients with acute coronary syndrome,but is not related to the prognosis of patients with stable coronary artery disease.So RAR could be used to assess long-term adverse events in patients with cardiovascular disease.