The prognostic value of albumin-corrected anion gap for major adverse cardiac events in chronic kidney disease patients undergoing percutaneous coronary intervention

Background Cardiovascular disease currently holds the highest morbidity and mortality rates globally. The survival of patients with coronary artery disease (CAD) complicated by chronic kidney disease (CKD) remains a significant threat, posing challenges in management and timely treatment. This study aims to explore the relationship between the Albumin-Corrected Anion Gap (ACAG) and the prognosis of patients with CKD Receiving Percutaneous Coronary Intervention. Methods This was a single-center, retrospective study including 973 patients who underwent percutaneous coronary intervention (PCI) at Tianjin Medical University Second Hospital from January 2019 to June 2023, all with an estimated glomerular filtration rate (eGFR) of less than or equal to 60 mL/min/1.73 m 2 . Follow-up was completed in June 2023. The primary efficacy endpoint was the time-to-first occurrence of major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, recurrent myocardial infarction (MI), or non-fatal stroke. The key secondary endpoint was all-cause mortality, Additional secondary endpoints included (1) the individual components of the primary composite, (2) recurrent MACE (i.e., events after the first occurrence), and (3) any repeat revascularization. Results After a follow-up of 918.0 ± 364.7 days, 205 MACEs were recorded. Receiver Operating Characteristic (ROC) curve analysis identified the optimal cutoff value for trial subjects. Compared to the low-ACAG group, the high-ACAG group exhibited a higher incidence of MACEs (29.65% vs. 15.78%, P < 0.001) and all-cause mortality (29.92% vs. 11.96%, P < 0.001). The Kaplan–Meier survival curve indicated that the low-ACAG group had a higher survival rate. Restricted cubic spline (RCS) analysis suggested that ACAG was positively correlated with MACE events. Univariate and multivariate Cox regression analysis indicated that a high ACAG level (HR: 1.820;95%CI: 1.300–2.546, P < 0.001) and the use of diuretics during hospitalization (HR: 1.653;95%CI: 1.195–2.286, P = 0.002) were independently associated with the occurrence of MACEs in patients with CAD and CKD. After adding ACAG and eGFR to the traditional risk model, Decision Curve Analysis (DCA) pointed out that DCA could improve the clinical net benefit within a certain range. Conclusions Among patients undergoing PCI treatment for chronic kidney disease, elevated ACAG levels are closely related to the patient's cardiac mortality and all-cause mortality rates. Additionally, the use of diuretics in patients with CAD and CKD requires caution and should optimize treatment strategies.