High albumin-corrected anion gap linked to increased MACE risk in CKD patients after PCI

A retrospective cohort study examined the prognostic value of albumin-corrected anion gap (ACAG) in 973 chronic kidney disease patients (estimated glomerular filtration rate ≤ 60 mL/min/1.73 m²) undergoing percutaneous coronary intervention at Tianjin Medical University Second Hospital. Patients were categorized into high and low ACAG groups based on a receiver operating characteristic cutoff, with the low-ACAG group serving as the comparator.

The primary outcome was time-to-first major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, recurrent myocardial infarction, or non-fatal stroke. During a mean follow-up of 918.0 ± 364.7 days, the high-ACAG group experienced significantly higher MACE incidence (29.65%) compared to the low-ACAG group (15.78%), with P < 0.001. Secondary outcomes included all-cause mortality, individual MACE components, recurrent MACE, and any repeat revascularization, though specific results for these endpoints were not reported.

Safety and tolerability data were not reported. Key limitations include the single-center design and retrospective nature, which prevents causal inference. The study population was limited to Chinese patients with chronic kidney disease undergoing PCI, potentially limiting generalizability to other populations or settings. Funding sources and conflicts of interest were not reported.

For clinical practice, this study identifies an association between elevated albumin-corrected anion gap and worse cardiovascular outcomes in a specific patient population. However, given the observational design and single-center nature, these findings should be interpreted cautiously and require prospective validation before influencing clinical decision-making. The ACAG measurement may warrant further investigation as a potential prognostic marker in this population.