Increased serum albumin corrected anion gap levels are associated with increased incidence of new-onset HF and poor prognosis in patients with acute myocardial infarction

作者：Zhao, Bing; Li, Yilan; Lang, Xueyan; Fang, Shaohong; Li, Zhaoying; Li, Lulu; Xing, Lei^*; Zhang, Yao^*

来源：Clinica Chimica Acta, 2023, 544: 117354.

DOI：10.1016/j.cca.2023.117354

• Albumin corrected anion gap
• Metabolic acid load
• Acute myocardial infarction
• Post-myocardial infarction heart failure
• Mortality

Background: There is scant evidence on a relationship between metabolic acid load and acute myocardial infarction (AMI). We evaluated the relationship between serum albumin corrected anion gap (ACAG), a metabolic acid load biomarker, and post-myocardial infarction heart failure (post-MI HF) in patients with AMI.Methods: This prospective, single-center study enrolled 3,889 patients with AMI. The primary endpoint was the incidence of post-MI HF. Serum ACAG levels were calculated with the following formula: ACAG = AG + (40 [albuminemia in g/l]) x 0.25. Results: After correction for multiple confounding factors, patients in the fourth quartile of ACAG (highest serum ACAG levels) showed 33.5% higher risk of out-of-hospital HF [hazard ratio (HR) = 1.335, 95% CI = 1.034-1.724, p = 0.027], and 60% higher risk of in-hospital HF [odds ratio (OR) = 1.600, 95% CI = 1.269-2.017, p < 0.001] than those in the first quartile of ACAG (lowest serum ACAG levels). Altered levels of eGFR mediated 31.07% and 37.39% of the association between serum ACAG levels with out-of-hospital HF and in-hospital HF, respectively. Furthermore, altered levels of hs-CRP mediated 20.85% and 18.91% of the association between serum ACAG levels with out-of-hospital and in-hospital HF, respectively.Conclusion: Our study showed that higher metabolic acid load was associated with increased incidences of postMI HF in the AMI patients. Furthermore, deterioration of renal function and the hyperinflammatory state partially mediated the association between metabolic acid load and the incidence of post-MI HF.

• 单位
  哈尔滨医科大学; y