Relationship Between CRP/ALB Ratio and Severity of Coronary Artery Lesions in Hypertensive Patients with Acute Myocardial Infarction

Introduction

Hypertension significantly increases the risk of acute myocardial infarction (AMI). Studies have shown that elevated blood pressure not only exacerbates the degree of myocardial ischemia but is also closely associated with multiple severe complications, including heart failure, arrhythmias, and increased risk of death [1–3]. Coronary angiography (CAG) is considered the criterion standard for diagnosing AMI; however, it is an invasive procedure that carries certain risks and potential complications [4,5]. Cardiac-specific biomarkers such as troponin (cTn) and creatine kinase MB (CK-MB) play a crucial role in the diagnosis of AMI, particularly troponin, which is currently regarded as the most sensitive and specific marker [6,7]. However, elevations in these biomarkers are not exclusive to AMI; other conditions like liver disease and end-stage renal disease can also cause false-positive results [8]. Therefore, developing more sensitive and specific biomarkers and optimizing treatment strategies remain critical challenges in current clinical practice.

In recent years, an increasing number of studies have shown that inflammatory responses play a critical role in the development and progression of cardiovascular diseases [9]. C-reactive protein (CRP) is an important inflammatory marker for cardiovascular diseases. It has been reported that elevated CRP levels are closely associated with the severity of coronary artery lesions. However, using CRP alone may not be sufficient to comprehensively assess a patient’s inflammatory status, as it can be influenced by various factors such as infections and inflammatory diseases [10]. ALB is an indicator of nutritional status and inflammation degree [11]. Low ALB levels have become an independent predictor of coronary artery disease and other cardiovascular diseases [12]. In patients with ST-elevation myocardial infarction (STEMI) who underwent direct percutaneous coronary intervention (PCI), the uric acid/albumin ratio was a predictor of intracoronal thrombotic severity [13]. The CRP/ALB ratio combines the effects of inflammatory response and nutritional status, providing a more comprehensive reflection of the patient’s overall condition [14,15]. Multiple studies have shown that the CRP/ALB ratio holds significant importance in prognostic assessments across various diseases, particularly in cancer and acute pancreatitis [16–18]. It has been reported that the combination of CRP and albumin has high predictive value for in-hospital mortality and out-of-hospital major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) in AMI patients (AUC of 0.850, sensitivity of 87.5%, and specificity of 70.6%) [19]. However, there is a lack of research assessing the severity of AMI in hypertensive patients using the CRP/ALB ratio. In this study, we investigated the correlation between the CRP/ALB ratio and the severity of coronary artery lesions and prognosis. By monitoring changes in the CRP/ALB ratio, doctors can promptly adjust treatment strategies during disease progression, thereby improving treatment outcomes.

Material and Methods

STUDY DESIGN AND PARTICIPANTS:

This single-center, hospital-based, cross-sectional observational study evaluated the severity of coronary artery disease in patients with acute myocardial infarction (AMI) and a history of hypertension. We included a consecutive sample of 100 patients admitted for AMI treatment who also had a history of hypertension. All patients underwent coronary angiography within 48 hours of symptom onset to assess the extent of coronary artery lesions.

INCLUSION AND EXCLUSION CRITERIA:

Inclusion criteria: (1) Hypertensive patients aged 30–70 years. (2) Hypertension diagnosed using a calibrated electronic sphygmomanometer to measure systolic and diastolic blood pressure while resting, measured at least twice, with a 5-minute interval between measurements. If both measurements met the diagnostic criteria for hypertension (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg), then hypertension was confirmed. Alternatively, a history of hypertension could be confirmed if the patient was currently undergoing antihypertensive drug therapy. (3) Clinically diagnosed acute myocardial infarction (AMI) confirmed by electrocardiogram (ECG) showing ST-segment elevation or new left bundle branch block. (4) Elevated blood markers (eg, high troponin levels). (5) Completed coronary angiography within 48 hours of the onset of the disease. (6) Able to provide complete clinical data and serum samples. (7) Signed informed consent and agreed to participate in the study.

Exclusion criteria: (1) Younger than 30 or older than 70 years. (2) Had undergone cardiac surgery or interventional treatment. (3) Had other significant cardiovascular diseases such as severe heart failure or arrhythmias. (4) Had severe liver or kidney dysfunction or inflammatory diseases. (5) Pregnant or breastfeeding women. (6) Unable to comply with study requirements.

DATA COLLECTION:

This study systematically extracted the detailed medical history of patients through the electronic medical record system of the hospital, and collected clinical data, including age, sex, smoking history, and diabetes. Venous blood samples were collected from all patients on an empty stomach in the early morning, and serum was separated and stored at −80°C for subsequent testing. The serum CRP level was measured by high-sensitivity enzyme-linked immunosorbent assay (ELISA) and the serum ALB level was measured by biochemical methods. Among them, CRP ELISA kit (JL13865-96T, detection range: 31.25–2000 pg/mL; Sensitivity: 15.9 pg/mL) was purchased from Jianglai Biological. The CRP/ALB ratio was calculated as the CRP level divided by the ALB level.

:

The Gensini score is the sum of the scores for the degree of coronary artery stenosis and the location of lesions. The scoring for the degree of stenosis was as follows: the stenosis degree 1–25% was recorded as 1 point; 26–50% as 2 points; 51–75% as 4 points; 76–90% as 8 points; 91–99% as 16 points; and 100% as 32 points. The lesion score is the product of the individual lesion score and a coefficient, which indicates the importance of stenosis at different locations in the coronary artery system. The coefficients for each location are as follows: left main stem is 5; proximal left anterior descending (LAD) is 2.5; mid-LAD is 1.5; aorta and first diagonal branch is 1; second diagonal branch is 0.5; distal LAD is 1; proximal left circumflex (LCX) is 2.5; mid-LCX is 2.5; distal LCX is 1; obtuse marginal branch is 0.5; proximal right coronary artery (RCA) segment is 1; mid-RCA is 1; distal RCA is 1; posterior descending artery is 1; and left ventricular posterior branch is 0.5. A Gensini score of 1–30 is considered mild, 31–60 is moderate, and >60 is severe.

FOLLOW-UP AND PROGNOSTIC ASSESSMENT:

Patients were followed up for 2 years after discharge via outpatient visits or telephone calls, with evaluations conducted every 3 months. The follow-up period aimed to document poor prognosis, including heart failure, recurrent acute myocardial infarction (AMI), cardiogenic shock, and death from cardiovascular events (MACE).

STATISTICAL ANALYSIS:

GraphPad Prism 9.50 software (GraphPad Software, Inc., San Diego, CA, USA) was used for statistical analysis and graphing of data. Measurement data with a normal distribution are expressed as the mean±standard deviation and analyzed by t tests or one-way analysis of variance (ANOVA) for comparison between groups. Measurement data with a non-normal distribution are expressed as medians (interquartile range) and compared using the Mann-Whitney U test. Enumeration data are expressed as frequencies or percentages and analyzed by the chi-squared test. The correlation between the CRP/ALB ratio and the severity of coronary artery lesions was analyzed using Pearson’s correlation coefficient. The Kaplan-Meier test and the log-rank test were used to compare the distributions and plot the curves of poor prognosis for hypertensive patients with AMI. P values were obtained from two-tailed tests, with P<0.05 considered statistically significant.

Results

A total of 100 cases of acute myocardial infarction (AMI) in hypertensive patients were included in the study. The patients ranged in age from 32 to 68 years old, with an average age of 52.7±15.2 years old, including 56 men and 44 women. There were 50 (50%) who had a smoking history, and 35 (35%) had diabetes.

According to the results of Gensini scores, the patients were divided into a mild lesions group (n=35), a moderate lesions group (n=45), and a severe lesions group (n=20). The mean Gensini score was 18.5±5.5 in the mild lesions group, 48.6±8.0 in the moderate lesions group, and 85.2±6.9 in the severe lesions group.

The CRP/ALB ratio was 0.14±0.03for the mild lesions group, 0.25±0.05 for moderate lesions group, and 0.40±0.06 for the severe lesions group (Figure 1).

Pearson correlation coefficient analysis showed a striking positive correlation between CRP/ALB ratio and Gensini score in coronary artery disease. The strength of this association is reflected by a Pearson correlation coefficient (r) value of 0.630, which has a significance level (P value) of less than 0.001, further strengthening the reliability of this association. This discovery has generated much interest and discussion in the medical field. The positive correlation between CRP/ALB ratio, as a comprehensive reflection of inflammation indicator and nutritional status, and Gensini score of coronary artery disease suggests a correlation between high inflammation level and worse cardiovascular disease severity. This result may have important clinical implications for the diagnosis, prevention, and treatment of cardiovascular diseases (Figure 2).

Based on the median value of the CRP/ALB level, hypertensive patients with AMI were divided into a low-expression group and a high-expression group. The 2-year poor prognosis conditions of the 2 groups were compared. The results showed that the poor prognosis rate of patients in the high CRP/ALB group (40.00%) was significantly higher than that in the low CRP/ALB group (16.00%) (P=0.008), as shown in Table 1. In addition, the curves of poor prognosis for hypertensive patients with AMI were plotted according to the distribution comparison of the Kaplan-Meier curve and the log-rank test. The results showed that the KM curve of patients in the high CRP/ALB expression group shifted to the left compared with that of patients in the low CRP/ALB expression group (P=0.010) (Figure 3), indicating that high serum CRP/ALB increases the risk of poor prognosis in hypertensive patients with AMI.

Discussion

s study explored the relationship between the CRP/ALB ratio and the severity of coronary artery lesions in hypertensive patients with acute myocardial infarction. The results revealed a significant positive correlation between the CRP/ALB ratio and the severity of coronary artery lesions. As the severity of lesions increased, the CRP/ALB ratio also increased. This suggests that the CRP/ALB ratio might serve as a potential biomarker for evaluating the extent of coronary artery lesions in hypertensive patients with acute myocardial infarction.

Inflammation plays a crucial role in the occurrence and development of acute myocardial infarction [13,21]. CRP is an acute-phase protein that reflects the inflammatory state of the body [22]. Elevated levels of CRP can be used to identify patients at risk of cardiovascular disease and certain cancers, and guide treatment in an environment-dependent manner [23]; ALB levels are typically influenced by nutritional status and the degree of inflammation [11]. In an inflammatory state, liver cells may be damaged or dysfunctional, decreasing in their ability to synthesize proteins [24,25], and their ratio can reflect the comprehensive impact of inflammation and body nutrition on coronary artery disease. The change of this ratio may indicate that there is a close relationship between inflammation and the progression of coronary atherosclerosis in patients with hypertension and AMI. Inflammation can promote the instability and rupture of atherosclerotic plaque through a variety of ways, thus leading to the occurrence of AMI and the aggravation of coronary artery disease [10,26,27].

The CRP/ALB ratio not only considers the impact of inflammation, but also incorporates the assessment of nutritional status, thus providing a more comprehensive reflection of the patient’s overall condition [28]. The CRP/ALB ratio is more closely associated with the severity of coronary artery disease than the use of CRP and ALB alone [29]. The CRP/ALB ratio is an new independent predictor of long-term adverse outcomes in coronary heart disease patients undergoing percutaneous coronary intervention (PCI) [30]. In this study, there was a significant positive correlation between the CRP/ALB ratio and the severity of coronary artery disease, indicating that as the severity of coronary artery disease increased, the CRP/ALB ratio significantly increased. In addition, higher serum CRP/ALB levels increase the risk of poor outcomes in hypertensive patients with AMI. CRP/ALB can be used to assess the severity of coronary artery lesions and also to predict the long-term prognosis of patients. This has important guiding significance for clinicians to formulate personalized treatment plans and follow-up programs. For example, a higher CRP/ALB ratio indicates strong inflammatory responses and poor nutritional status. Clinicians can use this information to increase the frequency of patient monitoring, such as by increasing the frequency of follow-up blood tests and echocardiograms to promptly identify potential risks. Additionally, in terms of treatment, they can consider intensifying anti-inflammatory therapy, providing appropriate nutritional supplementation, and adjusting medication regimens to improve patient outcomes and actively prevent adverse cardiovascular events.

This study has some limitations: the sample size was small and limited to a specific patient population, which may affect the external validity of the results. There are confounding factors that are not fully controlled (eg, age, sex, comorbidities, medication use), which may affect the expression of CRP/ALB ratio. In addition, the molecular and cellular mechanisms involved in the association of CRP/ALB ratio with coronary artery disease, as well as their specific roles in pathological and physiological processes, have not been thoroughly explored. Therefore, the present study needs to be validated in larger and more diverse cohorts, exploring the molecular and cellular mechanisms involved in the association between the CRP/ALB ratio and coronary artery disease, exploring its role in pathological and physiological processes, and further evaluating its practical utility.

Conclusions

The study showed that in hypertensive patients with acute myocardial infarction, there was a positive correlation between the CRP/ALB ratio and the severity of coronary artery lesions. The higher the ratio was, the more severe the lesions were, and higher serum CRP/ALB levels increased the risk of poor prognosis. Therefore, the CRP/ALB ratio could serve as a potential indicator for evaluating the degree of coronary artery lesions and the prognosis of patients, providing guidance for clinical treatment.