Wang Si-Fan, Wu Ting-Ting, Zheng Ying-Ying, Hou Xian-Geng, Yang Hai-Tao, Yang Yi, Xie Xiang
Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, China.
Rev Cardiovasc Med. 2023 Oct 7;24(10):278. doi: 10.31083/j.rcm2410278. eCollection 2023 Oct.
Coronary heart disease is one of the main causes of Mortality. Many biological indicators have been used to predict the prognosis of patients with coronary heart disease. The ratio of serum globulin to albumin (GAR) has been used to predict the prognosis of patients with various cancers. It has been proven that GAR is related to the prognosis of patients with stroke. However, GAR's role in cardiovascular disease remains unclear. Our purpose was to investigate the predictive value of GAR on clinical outcomes in post-percutaneous coronary intervention (PCI) patients with coronary artery disease (CAD).
From Dec. 2016 to Oct. 2021, a total of 14,994 patients undergoing PCI patients admitted to the First Affiliated Hospital of Xinjiang Medical University were divided into high GAR group (GAR 0.76, n = 4087) and low GAR group (GAR 0.76, n = 10,907). The incidence of adverse outcomes including all-cause mortality (ACM), cardiovascular mortality (CM), major adverse cardiovascular events (MACE) and major adverse cardiovascular and cerebrovascular events (MACCE) was compared between the two groups. Multivariate Cox regression was used to adjust for the effects of confounding factors, while hazard ratios (HRs) and 95% confidence intervals (95% CI) were calculated. Median follow-up time was 24 months.
Compared with the low GAR group, the high GAR group had significantly higher incidence of ACM (6.5% vs. 1.7%, 0.001); CM (4.9% vs. 1.2%, 0.001), MACE (10.5% vs. 6.7%, 0.001), and MACCE (11.3% vs. 7.5%, 0.001). Cox regression analysis showed the patients in the high GAR group had a 1.62-fold increased risk for ACM (HR = 2.622, 95% CI: 2.130-3.228, 0.01), a 1.782-fold increased risk for CM (HR = 2.782, 95% CI: 2.180-3.550, 0.01). There was a 37.2% increased risk for MACE (HR = 1.372, 95% CI: 1.204-1.564, 0.01), and 32.4% increased risk for MACCE (HR = 1.324, 95% CI: 1.169-1.500, 0.01), compared to the patients in the low GAR group.
The present study suggested that post-PCI CAD patients with higher GAR presented significantly increased mortality and adverse events GAR level at admission may 296 be considered as part of risk stratification when PCI is possible in patients with coronary heart disease.
The detailed information of the PRACTICE study has been registered on http://Clinicaltrials.gov (Identifier: NCT05174143).
冠心病是主要死因之一。许多生物学指标已被用于预测冠心病患者的预后。血清球蛋白与白蛋白比值（GAR）已被用于预测各种癌症患者的预后。已证实GAR与中风患者的预后相关。然而，GAR在心血管疾病中的作用仍不清楚。我们的目的是研究GAR对经皮冠状动脉介入治疗（PCI）后冠心病（CAD）患者临床结局的预测价值。
2016年12月至2021年10月，新疆医科大学第一附属医院共14994例接受PCI治疗的患者被分为高GAR组（GAR≥0.76，n = 4087）和低GAR组（GAR＜0.76，n = 10907）。比较两组包括全因死亡率（ACM）、心血管死亡率（CM）、主要不良心血管事件（MACE）和主要不良心血管和脑血管事件（MACCE）在内的不良结局发生率。采用多因素Cox回归调整混杂因素的影响，同时计算风险比（HR）和95%置信区间（95%CI）。中位随访时间为24个月。
与低GAR组相比，高GAR组的ACM发生率显著更高（6.5%对1.7%，P＜0.001）；CM发生率（4.9%对1.2%，P＜统一码: 0.001）、MACE发生率（10.5%对6.7%，P＜0.001）和MACCE发生率（11.3%对7.5%，P＜0.001）。Cox回归分析显示，高GAR组患者的ACM风险增加1.62倍（HR = 2.622，95%CI：2.130 - 3.228，P＜0.01），CM风险增加1.782倍（HR = 2.782，95%CI：2.180 - 3.550，P＜0.01）。与低GAR组患者相比，MACE风险增加37.2%（HR = 1.372，95%CI：1.204 - 1.564，P＜0.01），MACCE风险增加32.4%（HR = 1.324，95%CI：1.169 - 1.500，P＜0.01）。
本研究表明，PCI术后GAR较高的CAD患者死亡率和不良事件显著增加。入院时的GAR水平在冠心病患者可能进行PCI时可被视为风险分层的一部分。
