Prognostic impact of follow-up serum albumin after acute myocardial infarction

Abstract

Aims: Previous studies have suggested that low serum albumin (LSA) at admission for acute myocardial infarction (AMI) is associated with adverse in-hospital outcomes. The aim of this study was to investigate whether LSA in the remote phase after AMI is prognostic for long-term outcomes. Methods and results: This was a single-centre, retrospective study of consecutive patients admitted for AMI from 2008 to 2016. Serum albumin concentrations were measured serially at admission and 1 year after discharge in Japanese patients. Occurrence of a composite of hospitalization for heart failure and cardiovascular death was the primary endpoint. The prognostic impact of remote LSA, defined as a serum albumin level < 3.8 g/dL at 1 year after discharge, was investigated with a multivariate-adjusted Cox model. Among 1424 subjects analysed, 289 (20.3%) had LSA at admission, and 165 (11.6%) had LSA at 1 year after discharge. During follow-up (median: 4.1 years), the primary endpoint occurred in 31/165 (18.8%) patients with remote LSA and 42/1259 (3.3%) patients without it [adjusted hazard ratio (aHR), 2.76; 95% confidence interval (CI), 1.32 to 5.72; P = 0.007]. The all-cause death rate was 29.7% (49/165) in patients with remote LSA and 4.3% (54/1259) in patients without it (aHR, 4.02; 95% CI, 2.36 to 6.87; P < 0.001). The prognostic impact of remote LSA was consistent across albumin status in the acute phase of AMI. Conclusions: Regardless of albumin status in the acute phase of AMI, LSA in the remote phase after AMI was significantly associated with long-term adverse outcomes.