The High-Sensitivity C-Reactive Protein to Prealbumin Ratio Predicts Adverse Cardiovascular Events after ST-Elevation Myocardial Infarction
DOI:
https://doi.org/10.1532/hsf.3307Keywords:
ST-elevation myocardial infarction, major adverse cardiac events, high sensitivity C-reactive protein to prealbumin ratio, biomarkerAbstract
Background: This study evaluated the association of the high-sensitivity C-reactive protein to prealbumin ratio (CPR) with adverse cardiovascular events after ST-elevation myocardial infarction (STEMI) in patients undergoing primary percutaneous coronary intervention (PCI).
Methods: The study included 682 patients who presented with STEMI and were treated with primary PCI. Patients were divided into 2 groups: high CPR (CPR ≥0.02) and low CPR (CPR <0.02). The primary endpoint of the study was the occurrence of major adverse cardiovascular events (MACE), defined as cardiovascular mortality or admission due to recurrent AMI or heart failure. Multivariate Cox regression models were used to assess the prognostic value of CPR on MACE in patients with STEMI.
Results: During a median follow-up of 18 months, the accumulated incidence rate of MACE was significantly higher in the high-CPR group than in the low-CPR group (38.7% versus 12.0%, P < .01). Multivariate analysis revealed that CPR was an independent predictor for increased risk of MACE (hazard ratio = 3.27, 95% confidence interval [CI] 2.14 to 4.49, P < .01). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve for predicting the diagnosis of MACE was higher for CPR (0.82, 95% CI 0.77 to 0.87) than hs-CRP (0.70, 95% CI 0.65 to 0.75).
Conclusion: CPR was independently associated with MACE and can be used for risk stratification in patients with STEMI.
References
Aguilar D, Fisher MR, O’Connor CM., et al. Metabolic syndrome, C-reactive protein, and prognosis in patients with established coronary artery disease. Am Heart J 2006;152:298-304.
Cagdas M, Rencuzogullari I, Karakoyun S, et al. Assessment of relationship between C-reactive protein to albumin ratio and coronary artery disease severity in patients with acute coronary syndrome. Angiology 2019;70:361-368.
China Society of Cardiology of Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology. Guideline on the diagnosis and therapy of ST-segment elevation myocardial infarction. Zhonghua Xin Xue Guan Bing Za Zhi 2015;43:380-93 [in Chinese].
Dind A, Allahwala U, Asrress KN, et al. Contemporary management of ST-elevation myocardial infarction. Heart Lung Circ 2017;26:114-121.
Fairclough E, Cairns E, Hamilton J, et al. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med (Lond) 2009;9:30-33.
Feng JF, Wang L, Jiang YH, et al. C-reactive protein to prealbumin ratio (CPR): A novel inflammatory-nutritional prognostic factor for predicting cancer-specific survival (CSS) and overall survival (OS) in patients with resectable esophageal squamous cell carcinoma. J Oncol 2019;2019:4359103.
Friberg L, Drvota V, Bjelak AH, et al. Association between increased levels of reverse triiodothyronine and mortality after acute myocardial infarction. Am J Med 2001;111:699-703.
Gach O, Legrand V, Biessaux Y, et al. Long-term prognostic significance of high-sensitivity C-reactive protein before and after coronary angioplasty in patients with stable angina pectoris. Am J Cardiol 2007;99:31-35.
Kalantar-Zadeh K, Anker SD, Horwich B, et al. Nutritional and anti-inflammatory interventions in chronic heart failure. Am J Cardiol 2008;101:89E-103E.
Karabag Y, Cagdas M, Rencuzogullari I, et al. Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. J Clin Lab Anal 2018;32:e22457.
Kojima S, Matsui K, Ogawa H, et al. Temporal trends in hospitalization for acute myocardial infarction between 2004 and 2011 in Kumamoto, Japan. Circ J 2013;77:2841-2843.
Kotecha T, Rakhit RD. Acute coronary syndromes. Clin Med (Lond) 2016;16(suppl 6):s43-s48.
Li G, Hu R, Guo Y, et al. Circulating sulfatide, a novel biomarker for ST-segment elevation myocardial infarction. J Atheroscler Thromb 2019;26:84-92.
Li L, Dai L, Wang X, et al. Predictive value of the C-reactive protein-to-prealbumin ratio in medical ICU patients. Biomark Med 2017;11:329-337.
Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2095-2128.
Luc G, Bard JM, Juhan-Vague I, et al. C-reactive protein, interleukin-6, and fibrinogen as predictors of coronary heart disease: The PRIME Study. Arterioscler Thromb Vasc Biol 2003;23:1255-1261.
Perers E, Caidahl K, Herlitz J, et al. Treatment and short-term outcome in women and men with acute coronary syndromes. Int J Cardiol 2005;103:120-127.
Raposeiras Roubin S, Abu Assi E, Cespon Fernandez M, et al. Prevalence and prognostic significance of malnutrition in patients with acute coronary syndrome. J Am Coll Cardiol 2020;76:828-840.
Sahyoun NR, Jacques PF, Russell RM. Carotenoids, vitamins C and E, and mortality in an elderly population. Am J Epidemiol 1996;144:501-511.
Thiele JR, Zeller J, Kiefer J, et al. A conformational change in C-reactive protein enhances leukocyte recruitment and reactive oxygen species generation in ischemia/reperfusion injury. Front Immunol 2018;9:675.
Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation 2012;126:2020-2035.
Wang CH, Li SH, Weisel RD, et al. C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle. Circulation 2003;107:1783-1790.
Wang W, Ren D, Wang CS, et al. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med 2019;13:811-820.
Zhang K, Liu L, Cheng X, et al. Low levels of vitamin C in dialysis patients is associated with decreased prealbumin and increased C-reactive protein. BMC Nephrol 2011;12:18.
