C-Reactive Protein to Albumin Ratio Predict In-Hospital and Long-term Outcome of ST-Segment-Elevation Myocardial Infarction Patients with SARS-CoV2 Infection Underwent Fibrinolytic Therapy.
New Direction of STEMI Care In COVID-19 Pandemic
Keywords:
STEMI, COVID-19, Fibrinolytic, CRP, Albumin
Abstract
Background: The choice of reperfusion therapy in STEMI patients with COVID-19 is unclear. CRP to Albumin ratio (CAR) found to be a predictor of thrombus burden. This study was to determine the relationship and predictive value of CAR to in-hospital and long-term outcome of STEMI patients with COVID-19 treated with fibrinolytic.
Methods: 297 COVID-19 patients with STEMI underwent fibrinolytic were enrolled. In-hospital outcomes were in-hospital mortality due to cardiovascular death which was divided into mortality <48 hours and >48 hours, fibrinolytic failure, and cardiogenic shock. The presence of reinfarction post fibrinolytic and mortality after the patient discharged was assessed as the long-term outcome.
Results: During follow-up, 19.8% experienced in-hospital mortality and 16.1% had reinfarction. In the in-hospital outcome, patients with in-hospital death, failed fibrinolytic and cardiogenic shock had higher CAR (6.7+2.4 vs 4.7+1.9; 6.3+1.9 vs 2.1+1.6; 5.5+2.1vs1.8+1.5) with all p-value <0.05. CAR with an optimal cut-off >4.46 can be a predictor of fibrinolytic failure with sensitivity of 86.7% and specificity of 93.6% (PR19.82; 95%CI 10.32-38.06) and predictor of in-hospital death <48 hours with sensitivity of 84.6% and specificity of 82.7% (PR5.02; 95%CI 3.20-7.90). In the long-term outcome, patients who experienced reinfarction and out-hospital death had higher CAR (5.1+1.2vs2.5+2.4; 5.2+1.3vs2.6+2.4) than those who did not experience the event respectively with all p-value <0.05. CAR with an optimal cut-off >3.67 can be predictor of reinfarction with sensitivity of 87.5% and specificity of 73.5% (PR12.250; 95%CI 5.38-27.87). The Cox regression model showing CAR >3.67 was also associated with higher reinfarction event (p=0.001).
Conclusion: CAR has the potential to be a predictor of in-hospital and long-term outcomes for STEMI patients with COVID-19 which can help determine which patients need more invasive strategy to prevent mortality and morbidity.
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References
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21. Ritschel VN, Seljeflot I, Arnesen H, Halvorsen S, Weiss T, Eritsland J, et al. IL-6 signalling in patients with acute STelevation myocardial infarction.Res Immunol 2014;4:8–13.doi: 10.1016/j.rinim.2013.11.002.
22. Ridker PM, Rifai N, Rose L, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. New England journal of medicine. 2002;347:1557-65.
23. Hage F. C-reactive protein and hypertension. Journal of human hypertension. 2014;28:410-5.
24. Wang W, Ren D, Wang CS, Li T, Yao HC, Ma SJ. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019;13: 811-20.
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27. Mikhailidis D, Ganotakis E. Plasma albumin and platelet function: relevance to atherogenesis and thrombosis. Platelets. 1996;7:125-37.
28. Ganotakis ES, Vrentzos GE, Gazi IF, et al. Fibrinogen, lipoprotein (a), albumin and bilirubin (FLAB) levels and cardiovascular risk calculated using the Framingham equation. in vivo. 2007; 21: 685-94.
29. Klok F, Kruip M, Van der Meer N, et al. Incidence of thrombotic complicationsin critically ill ICU patients with COVID-19. Thrombosis research. 2020;191:145-7.
30. Zhu L, Chen M, Lin X. Serum albumin level for prediction of all-cause mortality in acute coronary syndrome patients: a meta-analysis. Bioscience Reports. 2020;40(1).
31. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. Journal of Allergy and Clinical Immunology 2020;146:110-118.
32. Oh J, Kim SH, Park KN, et al. High-sensitivity C-reactive protein/albumin ratio asia predictor of inhospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med. 2017;4:19-24.
33. Xie Q, Zhou Y, Xu Z, et al. The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury. BMC Nephrol. 2011;12:30.
34. Wang W, Ren D, Wang CS, Li T, Yao HC, Ma SJ. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019;13: 811-20.
35. Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. Creactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE. 2013;8:e59321.
36. Caixeta A, G´en´ereux P, Palmerini T, et al. Prognostic utility of the SYNTAX score in patients with single versus multivessel disease undergoing percutaneous coronary intervention (from the Acute Catheterization and Urgent Intervention Triage StrategY [ACUITY]trial). Am J Cardiol. 2014;113:203-10.
37. Garg S, Sarno G, Serruys P, Rodriguez A, Bolognese L, Anselmi M et al. Prediction of 1-Year Clinical Outcomes Using the SYNTAX Score in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. JACC: Cardiovascular Interventions. 2011;4(1):66-75.
38. von Meijenfeldt F, Havervall S, Adelmeijer J, Lundström A, Magnusson M, Mackman N et al. Sustained prothrombotic changes in COVID-19 patients 4 months after hospital discharge. Blood Advances. 2021;5(3):756-759.
39. Kirtane A, Bangalore S. Why Fibrinolytic Therapy for ST-Segment–Elevation Myocardial Infarction in the COVID-19 Pandemic Is Not Your New Best Friend. Circulation: Cardiovascular Quality and Outcomes. 2020;13(6).
40. Lacour T, Semaan C, Genet T, Ivanes F. Insights for increased risk of failed fibrinolytic therapy and stent thrombosis associated with COVID ‐19 in ST ‐segment elevation myocardial infarction patients. Catheterization and Cardiovascular Interventions. 2020;97(2).
41. Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet. 1996;348:771–775. doi: 10.1016/S0140-6736(96)02514-7
42. Parenica J, Kala P, Pavkova MG, et al. Natriuretic peptides, nitrite/nitrate and superoxide dismutase have additional value on top of the GRACE score in prediction of one-year mortality and rehospitalisation for heart failure in STEMI patients - Multiple biomarkers prospective cohort study. Int J Cardiol. 2016;211: 96-104.
43. Klingenberg R, Aghlmandi S, Ra¨ber L, et al. Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score. Eur Heart J Acute Cardiovasc Care. 2016;7; 129-138.
2. Garcia S, Dehghani P, Grines C, Davidson L, Nayak K, Saw J et al. Initial Findings From the North American COVID-19 Myocardial Infarction Registry. Journal of the American College of Cardiology. 2021;77(16):1994-2003.
3. Choudry FA, Hamshere SM, Rathod KS, et al. High thrombus burden in patients with COVID-19 presenting with ST-segment elevation myocardial infarction. J AmColl Cardio 2020;76:1168–76.
4. Kite T, Ludman P,Gale C, Wu J, Ca xeta A, MansouratiiJ et al. International Prospective Registry of Acute Coronary Syndromesiin Patients With COVID-19. Journal of the American College of Cardiology. 2021;77(20):2466-2476.
5. De Luca G, Debe N, Cercek M, Jensen L, Vavlukis M, Calmac L et al. Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechani cal reperfusion: Insights from the ISACS STEMI COVID 19 registry. Atherosclerosis.2021;332:48-54.
6. Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2017;39(2):119-177.
7. M.G. Kaya, F. Arslan, A. Abaci, G. vanider Heijden, T. Timurkaynak, A. Cengel. Myocardial blush grade: a predictor for major adverse cardiac events after primary PTCA with stent implantation for acute myocardial infarction. ActaiCardiologica. 2007;6 2(5):445-451.
8. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2—care pathways, treatment, and follow-up. Eur Heart J. 2021.
9. Hage, F. C-reactive protein and hypertension. Journal of human hypertension.20 14;28:410–5.
10. Danesh, J, Collins, R, Appleby, P, et al. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospectiv e studies. Jama. 1998;279:1477–82.
11. Gresele, P, Deckmyn, H, Huybrechts, E, et al. Serum albumin enhances the impairment of platelet aggregation with thromboxane synthase inhibition by increasing the formation of prostaglandin D2. Biochemical pharmacology. 1984;33:2083–2088.
12. Kayapinar, O, Ozde, C, Kaya, A. Relationship between the reciprocal change iniinflammation-related biomarkers (Fibrinogen-to-Albumin and hsCRP-to-Albumin ratios) and the presence and severity of coronary slow flow. Clinical and Applied Thrombosis/Hemostasis. 2019;25:1–10.
13. Quispe, Á, Li, X-M, Yi, H. Comparison and relationship of thyroid hormones, IL-6, IL-10 and albumin as mortality predictors in case-mix critically ill patients. Cytokine 2016; 81:94–100.
14. Zhang, J, Wang, X, Jia, X, et al. Risk factors for disease severity, unimprovement, and mortality of COVID-19 patients in Wuhan, China. Clinical Microbiology and Infection. 2020;26:767–72.
15. Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno Hiet al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2017;39(2):119-177.
16. Acet H, Güzel T, Aslan B, Isik M, Ertas F, Catalkaya S. Predictive Value of C-Reactive Protein to Albumin Ratio in ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention. Angiology. 2020;72(3):244-251.
17. Rencuzogullari I, Karabağ Y, Çağdaş M, Karakoyun S, Seyis S, Gürsoy M et al. Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction. Revista Portuguesa de Cardiologia. 2019;38(4):269-277.
18. Gheblawi M, Wang K, Viveiros A, Nguyen Q, Zhong JC, Turner AJ, et al. Angiotensin-converting enzyme 2: SARS-CoV-2 receptor and regulator of the renin-angiotensin system: celebrating the 20th anniversary of the discovery of ACE2. Circ Res 2020;126:1456–74. doi: 10.1161/CIRCRESAHA.120.317015.
19. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost 2020;18:1559–1561. doi: 10.1111/jth.14849.
20. Tanaka A, Shimada K, Sano T, Namba M, Sakamoto T, Nishida Y et al. Multiple Plaque Rupture and C-Reactive Protein in Acute Myocardial Infarction. Journal of the American College of Cardiology. 2005;45(10):1594-1599.
21. Ritschel VN, Seljeflot I, Arnesen H, Halvorsen S, Weiss T, Eritsland J, et al. IL-6 signalling in patients with acute STelevation myocardial infarction.Res Immunol 2014;4:8–13.doi: 10.1016/j.rinim.2013.11.002.
22. Ridker PM, Rifai N, Rose L, et al. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. New England journal of medicine. 2002;347:1557-65.
23. Hage F. C-reactive protein and hypertension. Journal of human hypertension. 2014;28:410-5.
24. Wang W, Ren D, Wang CS, Li T, Yao HC, Ma SJ. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019;13: 811-20.
25. Hartford M, Wiklund O, Mattsson Hulten L, et al. C-reactive protein, interleukin-6, secretory phospholipase A2 group IIA and intercellular adhesion molecule-1 in the prediction of late outcome events after acute coronary syndromes. J Intern Med. 2007;262:526-36.
26. ZairisiMN,iAdamopoulouiEN,iManousakisiSJ,ietial.iTheiimpactiofihsiC-reactiveiprot einiandiotheriinflammatoryibiomarkersionilong-termicardiovascularimortalityiinipatie ntsiwithiacuteicoronaryisyndromes.iAtherosclerosis.i2007;194:397-402.
27. Mikhailidis D, Ganotakis E. Plasma albumin and platelet function: relevance to atherogenesis and thrombosis. Platelets. 1996;7:125-37.
28. Ganotakis ES, Vrentzos GE, Gazi IF, et al. Fibrinogen, lipoprotein (a), albumin and bilirubin (FLAB) levels and cardiovascular risk calculated using the Framingham equation. in vivo. 2007; 21: 685-94.
29. Klok F, Kruip M, Van der Meer N, et al. Incidence of thrombotic complicationsin critically ill ICU patients with COVID-19. Thrombosis research. 2020;191:145-7.
30. Zhu L, Chen M, Lin X. Serum albumin level for prediction of all-cause mortality in acute coronary syndrome patients: a meta-analysis. Bioscience Reports. 2020;40(1).
31. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. Journal of Allergy and Clinical Immunology 2020;146:110-118.
32. Oh J, Kim SH, Park KN, et al. High-sensitivity C-reactive protein/albumin ratio asia predictor of inhospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med. 2017;4:19-24.
33. Xie Q, Zhou Y, Xu Z, et al. The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury. BMC Nephrol. 2011;12:30.
34. Wang W, Ren D, Wang CS, Li T, Yao HC, Ma SJ. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019;13: 811-20.
35. Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. Creactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS ONE. 2013;8:e59321.
36. Caixeta A, G´en´ereux P, Palmerini T, et al. Prognostic utility of the SYNTAX score in patients with single versus multivessel disease undergoing percutaneous coronary intervention (from the Acute Catheterization and Urgent Intervention Triage StrategY [ACUITY]trial). Am J Cardiol. 2014;113:203-10.
37. Garg S, Sarno G, Serruys P, Rodriguez A, Bolognese L, Anselmi M et al. Prediction of 1-Year Clinical Outcomes Using the SYNTAX Score in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. JACC: Cardiovascular Interventions. 2011;4(1):66-75.
38. von Meijenfeldt F, Havervall S, Adelmeijer J, Lundström A, Magnusson M, Mackman N et al. Sustained prothrombotic changes in COVID-19 patients 4 months after hospital discharge. Blood Advances. 2021;5(3):756-759.
39. Kirtane A, Bangalore S. Why Fibrinolytic Therapy for ST-Segment–Elevation Myocardial Infarction in the COVID-19 Pandemic Is Not Your New Best Friend. Circulation: Cardiovascular Quality and Outcomes. 2020;13(6).
40. Lacour T, Semaan C, Genet T, Ivanes F. Insights for increased risk of failed fibrinolytic therapy and stent thrombosis associated with COVID ‐19 in ST ‐segment elevation myocardial infarction patients. Catheterization and Cardiovascular Interventions. 2020;97(2).
41. Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet. 1996;348:771–775. doi: 10.1016/S0140-6736(96)02514-7
42. Parenica J, Kala P, Pavkova MG, et al. Natriuretic peptides, nitrite/nitrate and superoxide dismutase have additional value on top of the GRACE score in prediction of one-year mortality and rehospitalisation for heart failure in STEMI patients - Multiple biomarkers prospective cohort study. Int J Cardiol. 2016;211: 96-104.
43. Klingenberg R, Aghlmandi S, Ra¨ber L, et al. Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT, NT-proBNP and hsCRP with the GRACE score. Eur Heart J Acute Cardiovasc Care. 2016;7; 129-138.
Published
2022-06-30
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How to Cite
Prana Jagannatha, G. N., Rina Artha, I. M. J., Surya Pradnyana, I. W. A., & Kamardi, S. (2022). C-Reactive Protein to Albumin Ratio Predict In-Hospital and Long-term Outcome of ST-Segment-Elevation Myocardial Infarction Patients with SARS-CoV2 Infection Underwent Fibrinolytic Therapy. Indonesian Journal of Cardiology, 43(2), 64-76. https://doi.org/10.30701/ijc.1305
Section
Clinical Research
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