Abstract
Background: Alkaline phosphatase (ALP) and albumin (ALB) have been shown to be associated with coronary artery disease (CAD), and it has been reported that alkaline phosphatase-to-albumin ratio (AAR) is associated with the liver damage and poorer prognosis of patients with digestive system malignancy. Moreover, several previous studies showed that there was a higher incidence of malignancy in CAD patients. However, to our knowledge, the relationship between AAR and long-term adverse outcomes in CAD patients after undergoing percutaneous coronary intervention (PCI) has not been investigated. Therefore, we aim to access the relation between AAR and long-term adverse outcomes in post-PCI patients with CAD.Methods: A total of 3378 post-PCI patients with CAD were enrolled in the retrospective Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI (CORFCHD-ZZ) study from January 2013 to December 2017. The median duration of follow-up was 37.59 ± 22.24 months. The primary end point was long-term mortality including all-cause mortality (ACM) and cardiac mortality (CM). The secondary end points were major adverse cardiac events (MACEs) and major adverse cardiac and cerebrovascular events (MACCEs).Results: Kaplan–Meier analyses showed that an increased AAR was positively correlated with incidences of long-term ACM (log-rank, P=0.014), CM (log-rank, P=0.011), MACEs (log-rank, P=0.013) and MACCEs (log-rank, P=0.006). Multivariate Cox regression analyses showed that the elevated AAR was an independent predictor of long-term ACM (adjusted HR = 1.488 [1.031–2.149], P=0.034), CM (adjusted HR = 1.837 [1.141–2.959], P=0.012), MACEs (adjusted HR = 1.257 [1.018–1.551], P=0.033) and MACCEs (adjusted HR = 1.237 [1.029–1.486], P=0.024).Conclusion: An elevated AAR is a novel independent predictor of long-term adverse outcomes in CAD patients following PCI.
Highlights
Coronary artery disease (CAD) has been a major cause of mortality, and researches on coronary artery disease (CAD) have drawn intense attention worldwide [1]
Considering that Alkaline phosphatase (ALP) and ALB are involved in the onset, development and prognosis of CAD, it may be feasible to evaluate the potential value of alkaline phosphatase-to-albumin ratio (AAR) as a biomarker in predicting the adverse outcomes of CAD patients
The Receiver operating characteristic (ROC) curve showed that the cut-off value of AAR was 1.77, which divided a total of 3378 CAD patients after undergoing percutaneous coronary intervention (PCI) into two groups: the lower group (AAR < 1.77, n=1676) and the higher group (AAR ≥ 1.77, n=1702)
Summary
Coronary artery disease (CAD) has been a major cause of mortality, and researches on CAD have drawn intense attention worldwide [1]. Several previous studies showed that there was a higher incidence of malignancy in patients with CAD [20,21,22] It is unknown whether AAR is associated with adverse prognosis in CAD patients. To the best of our knowledge, there is no previous study investigating the relation between AAR and long-term adverse outcomes in post-PCI patients with CAD. Alkaline phosphatase (ALP) and albumin (ALB) have been shown to be associated with coronary artery disease (CAD), and it has been reported that alkaline phosphatase-to-albumin ratio (AAR) is associated with the liver damage and poorer prognosis of patients with digestive system malignancy. To our knowledge, the relationship between AAR and long-term adverse outcomes in CAD patients after undergoing percutaneous coronary intervention (PCI) has not been investigated.
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