Background

Robust, inexpensive biomarkers that capture the combined effects of systemic inflammation, tissue hypoperfusion, and nutritional reserve are needed to refine post–acute myocardial infarction (AMI) risk stratification—especially in the large subset that develops congestive heart failure (CHF). Two emerging candidates are the lactate/albumin ratio (LAR) and the red cell distribution width/albumin ratio (RAR). Separate studies have linked each ratio to short and long term mortality in critical illness, AMI, and heart failure, yet no work has directly compared their performance in a contemporary cardiac cohort, nor examined whether percutaneous coronary intervention (PCI) modulates their prognostic value. We addressed this evidence gap in a large, multi hospital dataset.

Methods

We performed a retrospective secondary analysis of 8 115 de identified encounters drawn from the HCA corporate database (2016 2024). Adults aged 30–80 years with laboratory confirmed AMI complicated by CHF and documented lactate, RDW, and albumin levels were included; those lacking 90 day follow up or requisite labs were excluded. The primary outcome was all cause mortality at 30, 60, and 90 days. Secondary outcomes were 7 , 15 , and 30 day readmissions. Predictors entered into generalized logistic regression were LAR, RAR, age, sex, race, and PCI status; interaction terms tested whether PCI modified biomarker effects. Model discrimination was assessed with the concordance (C) statistic.

Results

Elevated LAR and elevated RAR each independently increased the odds of death after adjustment for demographics and PCI. For LAR, the odds of mortality were nearly tripled (OR 2.99, 95 % CI 2.62–3.42; p < 0.001). RAR exerted a significant, but comparatively smaller, (OR 1.68, 95 % CI 1.50–1.89; p < 0.001). Age conferred a 3.8 % rise in mortality odds per year. Female sex, non White race, and receipt of PCI were protective (all p < 0.05). The full model achieved moderate discrimination (C = 0.708). Importantly, elevated LAR, but not RAR, predicted early clinical deterioration, being significantly associated with 7 , 15 , and 30 day readmissions. No significant interaction between PCI and either ratio was observed.

Conclusion

Both LAR and RAR are powerful, readily obtainable predictors of short term mortality in CHF patients recovering from AMI, with LAR also signaling imminent readmission risk. Routine calculation of these ratios at admission could sharpen bedside prognostication and prompt closer surveillance of high risk individuals. Incorporating LAR and RAR into post AMI care pathways warrants prospective validation and may foster a habit of leveraging routinely collected laboratory data for precision cardiovascular medicine.