Predictive Effect of C-reactive Protein Albumin Ratio on Long-term Adverse Cardiovascular Events in Patients with Type 2 Diabetes Mellitus and Acute Myocardial Infarction

Abstract

Background Acute Myocardial Infarction (AMI) remains one of the leading threats to global public health. Despite available reperfusion therapies, major adverse cardiovascular and cerebral events (MACCEs) associated with AMI continue to be a leading cause of death worldwide. This is particularly true for patients with AMI and concomitant diabetes mellitus, where coronary artery disease is more complex and severe, making early detection and prognosis of long-term outcomes for these patients challenging. Therefore, the identification of simple and accessible laboratory markers could facilitate the prediction of post-percutaneous coronary intervention (PCI) MACCEs in patients with type 2 diabetes mellitus (T2DM) and AMI. Objective To investigate the predictive value of the serum C-reactive protein (CRP) /albumin (Alb) ratio (CAR) for long-term MACCEs following PCI in patients with T2DM and AMI. Methods A total of 1 683 patients with T2DM and AMI treated at the Department of Cardiovascular Medicine, General Hospital of Ningxia Medical University between 2014 and 2019 were enrolled. General clinical data and test results were collected for these patients. Follow-ups were conducted via telephone or outpatient visits, with a median follow-up period of 5.6 years. MACCEs were defined as all-cause mortality, non-fatal myocardial infarction, recurrent unstable angina, non-fatal stroke, new-onset heart failure, or rehospitalization for worsening heart failure, and revascularization. Patients were divided into the MACCEs group (508 cases) and the non-MACCEs group (1 175 cases) based on the occurrence of MACCEs during the follow-up period. Univariate and multivariate Logistic regression analyses were performed to identify factors influencing MACCEs in patients with T2DM and AMI. Kaplan-Meier survival curves were plotted, and the Log-rank test was used for comparisons. Receiver operating characteristic (ROC) curve analysis assessed the predictive efficacy of CAR for long-term MACCEs in patients with T2DM and AMI, while the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices evaluated the improvement in prognostic assessment provided by CAR. Results Among the 1 683 patients, 508 (30.18%) experienced MACCEs. Multivariate Logistic regression analysis indicated that hypertension [OR (95%CI) =1.994 (1.142-3.483) ], length of coronary stent implanted [OR (95%CI) =1.031 (1.002-1.062) ], CRP [OR (95%CI) =0.950 (0.915-0.986) ], Alb [OR (95%CI) =0.933 (0.880-0.989) ], and CAR [OR (95%CI) =5.582 (1.705-18.277) ] were significant predictors of post-PCI MACCEs in patients with T2DM and AMI (P<0.05). Based on the median CAR level (0.86), patients were divided into two groups: CAR<0.86 and CAR≥0.86. The log-rank test showed that the incidence of MACCEs was significantly higher in the CAR≥0.86 group compared to the CAR<0.86 group (52.68% vs. 22.92%; χ2=65.65, P<0.001). The ROC curve indicated that the area under the curve (AUC) for CAR in predicting MACCEs in patients with T2DM and AMI was 0.728 (95%CI=0.702-0.754), with an optimal cut-off value of 0.576, sensitivity of 0.617, and specificity of 0.747. Compared to baseline models, CAR significantly improved the prediction of adverse cardio-cerebral events (NRI=0.377, IDI=0.166, C-index =0.690; P<0.05) . Conclusion CAR is an effective predictive marker for the risk of long-term MACCEs in patients with T2DM and AMI following PCI.

Keywords

• myocardial infarction|diabetes mellitus, type 2|major adverse cardiovascular and cerebral events|c-reactive protein|albumin|forecasting