Abstract
OBJECTIVE: The Albumin-to-D-dimer ratio (ADR), a novel systemic inflammatory marker, has been linked to adverse outcomes in patients with cardiovascular disease. However, limited research has explored its prognostic value in ST-elevation myocardial infarction (STEMI) survivors following hospital discharge. This study aimed to evaluate the prognostic significance of ADR in hospital-discharged STEMI patients. METHODS: In this retrospective study, we analyzed data from 2,675 STEMI patients admitted to our hospital between January 2014 and December 2021. Patients were stratified into two groups based on their natural logarithmic ADR (Ln ADR): a high Ln ADR group (≥3.998) and a low Ln ADR group (<3.998). Univariate and multivariate Cox regression analyses were performed to assess the association between Ln ADR levels and clinical outcomes, including all-cause mortality and new-onset stroke. RESULTS: Over a mean follow-up period of 1,013 days (interquartile range: 466-1,449 days), the incidence of major adverse cardiovascular events (MACE) was significantly higher in the low Ln ADR group compared to the high Ln ADR group (20.87% vs. 12.33%, P < 0.001). This disparity was particularly evident in all-cause mortality (6.58% vs. 1.00%, P < 0.001) and new-onset stroke (4.19% vs. 0.90%, P < 0.001). Multivariate analysis revealed that low Ln ADR was an independent predictor of all-cause mortality (HR = 2.46, 95% CI: 1.25-4.81, P = 0.009) and new-onset stroke (HR = 2.93, 95% CI: 1.35-6.35, P = 0.006). CONCLUSIONS: Reduced ADR levels were independently associated with increased long-term all-cause mortality and new-onset stroke in STEMI patients following hospital discharge. These findings suggest that ADR may serve as a valuable prognostic marker for risk stratification in this population.