[Changes in the binding properties of albumin in patients with myocardial infarction]

The purpose of the study was to measure the levels of albumin and to evaluate its binding properties in patients with acute large-focal myocardial infarction (AMI) hospitalized within the first 24 hours of AMI onset. Two groups were formed: group one--41AMI patients without cardiogenic shock (CS) and group two--15 patients with AMI complicated by true CS. Blood samples were taken from an ulnar vein on the first, second, third, fifth, seventh, and fourteenth day after AMI onset. The properties of binding albumin centers were determined using fluorescent method (K-35 probe). Total albumin concentration (TAC), effective albumin concentration (EAC), and albumin binding reserve (ABR) were determined. The results were presented as M +/- m. A significant increase in TAC on the fifth day (from 43 +/- 1 to 40 +/- 1 g/l) and EAC on the second, third, fifth, and seventh days (from 36 +/- 1 to 32 +/- 1 g/l with the minimal level on the fifth day), and in ABR on the second day (from 83.3 +/- 1.3 to 78.8 +/- 8%) were registered in group one. TAC returned to the normal level on the seventh day, EAC did not become normal until the fourteenth day, while ABR did not normalize within the period of two weeks. Eleven patients in group two died (hospital CS-associated mortality was 73.3%). TAC and EAC in discharged patients were 43.4 +/- 0.9 g/l and 35.8 +/- 0.8 g/l, respectively, while these parameters in the deceased were 35.5 +/- 1.7 g/l (p < 0.0001) and 27.3 +/- 1.7 g/l (p < 0.0001), respectively. CS developed in 70% of cases (seven out of ten patients) in whom TAC was less than 36 g/l vs. 17.4% of cases (eight out of 46) with a TAC of 36 g/l or more (p = 0.0013). When EAC was less than 30 g/l CS developed in 72.7% of cases (eight out eleven patients) vs. 15.6% of cases (seven out of 45) with an EAC of 30 g/l or more (p = 0.0003). Six out of ten patients (60%) with a TAC of less than 36 g/l died. Lethal outcome also occurred in five cases out of 46 or 10.9% with a TAL of 36 g/l or more (p = 0.0008). Seven out of eleven or 63.6% patients with an EAC of less than 30 g/l died. Four out of 45 patients (8.9%) with an EAC of 30 g/l or more died (p = 0.0001). Thus, the study found that a low (less than 36 g/l) TAC and EAC (less than 30 g/l) during the first 24 hours of AMI was associated with a significantly higher frequency of true CS and with a significantly higher hospital lethality. Determining albumin parameters during the first 24 hours of AMI will be useful in distinguishing a group of patients with a high risk of lethal outcome, which will make it possible to begin early aggressive therapy directed towards limiting myocardial necrosis.