الفهرس 
Prognostic Implications of Serum Albumin Levels in Patients with Acute Coronary Syndromes
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Abstract
Worldwide, ischaemic heart disease is the single most common cause of death and its frequency is increasing. However, in Europe, there has been an overall trend for a reduction in ischaemic heart disease mortality over the past three decades. Ischaemic heart disease accounts for almost 1.8 million annual deaths or 20% of all deaths in Europe, although with large variations between countries. (2)
The relative incidences of STEMI and NSTEMI are decreasing and increasing, respectively. (3) The mortality in STEMI patients is influenced by many factors, among them advanced age, Killip class, time delay to treatment, presence of emergency medical system-based STEMI net-works, treatment strategy, history of MI, diabetes mellitus, renal failure, number of diseased coronary arteries, and left ventricular Ejection fraction (LVEF). It is well known that lower concentrations of serum albumin can predict increased morbidity and mortality risks i Egypt.
n a range of cardiovascular diseases including ACS. (4)
Serum albumin (SA), the most important protein of the human serum, has several important physiological functions in the body. Serum albumin (SA) is also the main determinant of plasma oncotic pressure. Increased inflammatory response has been associated with decreasing synthesis and increasing catabolism of the albumin. (5) Lower serum albumin levels may increase blood viscosity and disrupt endothelial functions. (6, 7)
Additionally, serum albumin is an important inhibitor of platelet activation and aggregation and an important mediator of platelet-induced coronary artery narrowing. (4, 8)Moreover, one of the most important functions of serum albumin is its antioxidant activities. (9)
Decreased SA is also caused by increased leakage into the interstitial space, and accelerated catabolism. Longitudinal studies have provided robust evidence that a decrease in serum albumin concentration might be associated with an increased risk of cardiovascular diseases and heart failure. (10)
Rationale of the study:
Despite the great advancement in medical care, ACS remains a leading cause of morbidity and mortality. Accurate prediction of adverse prognosis is essential for better management of ACS.
Serum albumin is the principal negative acute phase reactant, levels of which decrease in inflammation during chronic systemic disease as well as acute critical illness. In acute coronary syndrome, the presence of hypoalbuminemia has been associated with increase severity of coronary lesions, long term mortality and development of heart failure