ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1574139
Predictive Value of the Serum Homocysteine-to-Albumin Ratio for Major Adverse Cardiovascular Events After Acute Myocardial Infarction: A Retrospective Cohort Study
Provisionally accepted
- Donghai hospital affiliated to Kangda college ,Nanjing medical university, Lianyungang, China
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Acute myocardial infarction (AMI) remains a major global health burden, with major adverse cardiovascular events (MACE) significantly affecting long-term prognosis. Although the Global Registry of Acute Coronary Events (GRACE) score is widely used for risk stratification, its complexity limits its clinical utility, especially in resource-limited settings. The serum homocysteine-to-albumin ratio (HAR) is a novel biomarker that combines oxidative stress and inflammatory processes, both of which play key roles in cardiovascular pathophysiology.This study aimed to assess the prognostic significance of HAR for MACE in AMI patients.A retrospective cohort study was conducted, including 421 AMI patients admitted to Donghai Hospital from January 2022 to December 2023. Clinical and laboratory data, including homocysteine (Hcy), albumin (Alb), and HAR, were collected. The primary outcome was MACE, defined as cardiovascular mortality, non-fatal myocardial infarction, heart failure, recurrent revascularization, stroke, and severe arrhythmias. Multivariable Cox regression analysis was performed to identify independent predictors of MACE. The predictive performance of HAR was assessed using receiver operating characteristic (ROC) curve analysis and compared with Hcy, Alb, and the GRACE score.During the 12-month follow-up period, 105 patients (24.9%) experienced MACE. The MACE group had significantly higher Hcy levels (15.7 ± 3.4 vs. 12.6 ± 3.1 μmol/L, P < 0.001) and lower Alb levels (34.2 ± 3.9 vs. 38.5 ± 4.2 g/L, P < 0.001). HAR was independently associated with MACE (HR = 1.41, 95% CI: 1.20-1.65, P < 0.001). ROC analysis demonstrated that HAR (AUC = 0.80) outperformed Hcy (AUC = 0.66) and Alb (AUC = 0.73) in predicting MACE, with predictive accuracy comparable to the GRACE score (AUC = 0.82).HAR is a strong and independent predictor of MACE in AMI patients. Given its simplicity, cost-effectiveness, and availability, HAR may serve as a valuable biomarker for cardiovascular risk stratification, especially in resource-limited settings. Further prospective studies are warranted to validate these findings and explore potential clinical applications.
Keywords: acute myocardial infarction, Homocysteine, albumin, Homocysteine-to-albumin ratio, Major adverse cardiovascular events, risk stratification, prognostic biomarker
Received: 10 Mar 2025; Accepted: 23 May 2025.
Copyright: © 2025 Wang, zhou, Wang, Fu, song, Hu, Wu and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Runfeng Sun, Donghai hospital affiliated to Kangda college ,Nanjing medical university, Lianyungang, China
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