Shechter Alon, Dahan Shani, Shiyovich Arthur, Gilutz Harel, Plakht Ygal
Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel.
J Cardiovasc Dev Dis. 2024 Nov 26;11(12):378. doi: 10.3390/jcdd11120378.
Serum albumin and body mass index (BMI, kg/m) have been associated with outcomes following acute myocardial infarction (AMI). Aiming to assess whether the mortality risk inflicted by hypoalbuminemia (<3.5 g/dL) in this context is influenced by BMI, we conducted a retrospective analysis of AMI survivors hospitalized during 2004-2017. Stratified by admission-time albumin level and BMI, eligible cases were evaluated for all-cause mortality up to 10 years after discharge. A total of 6283 individuals (74.1% males, mean age 64.1 ± 13.1 years, 44.3% with ST-elevation MI) were included. Of them, 22.7% had hypoalbuminemia and 1.2%, 41.0%, and 28.6% were underweight (BMI < 18.5), overweight (BMI 25-30), and obese (BMI ≥ 30), respectively. Over a median of 7.9 (IQR, 4.8-10.0) years of follow-up, 42.5% of patients died. Hypoalbuminemia was independently associated with a heightened mortality risk overall (AdjHR = 1.54, 95%CI 1.42-1.67, < 0.001), accounted for by the normal weight (AdjHR = 1.73, 95%CI 1.50-1.99, < 0.001), overweight (AdjHR = 1.55, 95%CI 1.35-1.79, < 0.001), and class 1 obesity (BMI 30-35) (AdjHR = 1.37, 95%CI 1.12-1.68, = 0.002) subgroups. Upon interaction analysis, the mortality risk imposed by hypoalbuminemia was most pronounced among individuals with normal BMI. In conclusion, hypoalbuminemia constituted a negative prognostic marker for long-term survival in AMI patients with normal or mildly elevated but not reduced or severely increased BMI. Pending further research, addressing hypoalbuminemia based on BMI range may prove beneficial.
血清白蛋白和体重指数（BMI，kg/m²）与急性心肌梗死（AMI）后的预后相关。为了评估在此背景下低白蛋白血症（<3.5 g/dL）所致的死亡风险是否受BMI影响，我们对2004年至2017年期间住院的AMI幸存者进行了一项回顾性分析。根据入院时的白蛋白水平和BMI进行分层，对符合条件的病例评估出院后长达10年的全因死亡率。共纳入6283例个体（74.1%为男性，平均年龄64.1±13.1岁，44.3%为ST段抬高型心肌梗死）。其中，22.7%有低白蛋白血症，1.2%、41.0%和28.6%分别为体重过轻（BMI<18.5）、超重（BMI 25 - 30）和肥胖（BMI≥30）。在中位随访7.9（IQR，4.8 - 10.0）年期间，42.5%的患者死亡。低白蛋白血症总体上与死亡风险升高独立相关（调整后风险比[AdjHR]=1.54，95%置信区间[CI] 1.42 - 1.67，P<0.001），在正常体重（AdjHR = 1.73，95%CI 1.50 - 1.99，P<0.001）、超重（AdjHR = 1.55，95%CI 1.35 - 1.79，P<0.001）和1级肥胖（BMI 30 - 35）（AdjHR = 1.37，95%CI 1.12 - 1.68，P = 0.002）亚组中均如此。经交互作用分析，低白蛋白血症所致的死亡风险在BMI正常的个体中最为明显。总之，对于BMI正常或轻度升高但未降低或严重升高的AMI患者，低白蛋白血症是长期生存的不良预后标志物。在进一步研究之前，根据BMI范围处理低白蛋白血症可能是有益的。
