Elevated albumin-corrected anion gap levels were associated with higher rates of adverse cardiovascular events and mortality in patients with chronic kidney disease undergoing percutaneous coronary intervention. A single-center retrospective study published in Frontiers in Cardiovascular Medicine assessed the association between albumin-corrected anion gap (ACAG) and clinical outcomes in patients with coronary artery disease (CAD) and chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI).
A total of 973 patients treated between January 2019 and June 2023 at Tianjin Medical University Second Hospital were included, all with an estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m². Follow-up was completed in June 2023. The primary endpoint was time to first major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, recurrent myocardial infarction (MI), or non-fatal stroke. Secondary endpoints included all-cause mortality, individual components of MACE, recurrent MACE, and repeat revascularization.
Over a mean follow-up of 918.0 ± 364.7 days, 205 MACE events were recorded. Receiver operating characteristic analysis identified an optimal ACAG cutoff. Patients with higher ACAG levels had a greater incidence of MACE (29.65% vs. 15.78%, p < 0.001) and all-cause mortality (29.92% vs. 11.96%, p < 0.001) compared with those with lower ACAG levels. Kaplan–Meier analysis showed higher survival in the low-ACAG group. Restricted cubic spline analysis demonstrated a positive association between ACAG levels and MACE.
Multivariate Cox regression analysis showed that elevated ACAG (HR: 1.820; 95% CI: 1.300-2.546; p < 0.001) and in-hospital diuretic use (HR: 1.653; 95% CI: 1.195-2.286; p = 0.002) were independently associated with MACE. Decision curve analysis showed improved net benefit after incorporating ACAG and eGFR into conventional risk models.
Elevated ACAG was associated with higher cardiovascular and all-cause mortality in patients with CKD undergoing PCI, with findings supporting its role in risk stratification.
