Albumin-to-Globulin ratio as an independent risk factor for predicting prognostic risk in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Purpose: Acute coronary syndromes (ACS) is a leading cause of death worldwide. Albumin and globulin are the main components of serum proteins. The albumin-to-globulin ratio (AGR) is often used to assess nutritional status. However, the clinical significance of the AGR in predicting the prognosis of patients with ACS remains unclear. Patients and methods: A total of 1408 patients with ACS who underwent percutaneous coronary intervention (PCI) were consecutively enrolled between January 2016 and December 2018 at The Affiliated Hospital of Chengde Medical University. The follow-up endpoints were defined as cardiac death or recurrent acute myocardial infarction. Results: A total of 1363 patients responded in the follow-up period, of whom 49 had MACEs. AGR was significantly different between the MACEs and non-MACE groups. The area under the curve for the AGR was 0.619 (p =0.004, 95% confidence interval [CI]: 0.542–0.697). The optimal cut-off value for the AGR was determined to be 1.350 using Youden’s index. The cumulative survival rate of the low AGR group was significantly lower than that of the high AGR group, according to the Kaplan-Meier curve (log-rank p=0.008). Multivariate Cox proportional hazards model showed age ≥60 years, HR:2.689 (95%CI:1.288-5.615, p=0.008), left ventricular ejection fraction (LVEF) <40%, HR: 3.527, (95%CI: 1.357–9.164, p=0.010), and AGR<1.350, HR: 2.180, (95%CI: 1.078–4.407, p=0.030) were all independent risk factors. A restricted cubic spline showed that a decreasing AGR was correlated with increasing risk of MACEs. Conclusion: AGR<1.350 is an independent prognostic risk factor for patients with ACS undergoing PCI and may be a valuable clinical marker for identifying high-risk patients. Clinical trial number: not applicable.