Microalbuminuria during acute coronary syndrome: Association with 22-year mortality and causes of death. The ABC-8* study on heart disease. (*ABC is an acronym for Adria, Bassano, Conegliano, and Padova Hospitals). (1st March 2023)

• Record Type: Journal Article
• Authors: Mahmoud, Heba T.; Berton, Giuseppe; Cordiano, Rocco; Palmieri, Rosa; Petucco, Stefania; Bagato, Francnesco
• Is Part Of: International journal of cardiology. Volume 374(2023)
• Page Start: 100
• Page End: 107
• Publication Date: 2023-03-01
• Subjects: Acute coronary syndrome -- Albumin creatinine ratio -- Microalbuminuria -- All-cause mortality -- Cardiac death -- Very long-term; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.12.025
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Microalbuminuria is associated with adverse outcomes in acute coronary syndrome (ACS) patients. Methods: To evaluate the very long-term association between Microalbuminuria and the overall mortality and causes of death in this clinical setting, we prospectively studied 579 unselected ACS patients admitted to three hospitals. The baseline albumin-to-creatinine ratio (ACR) was measured on days 1, 3, and 7 in 24-h urine samples. Patients were followed for 22 years or until death. Results: Virtually all patients completed follow-up; 449(78%) had died: 41% due to non-sudden cardiac death (non-SCD), 19% sudden cardiac death (SCD), 40% due to non-cardiac (non-CD) death. Using unadjusted Cox regression analysis, ACR was a significant predictor of all-cause mortality (hazard ratio [HR] 1.26;95%confidence interval [CI] 1.22–1.31; p˂0.0001) and the three causes of death (HR 1.40;95%CI 1.32–1.48; p˂0.0001), (HR 1.22;95%CI 1.12–1.32; p˂0.0001) and (HR 1.16;95%CI 1.09–1.23; p˂0.0001) for non-SCD, SCD and non-CD respectively. Using a fully adjusted model, ACR was a significant independent predictor of all-cause mortality (HR 1.12; 95%CI 1.08–1.16; p˂0.0001) and only non-SCD (HR 1.21; 95%CI 1.14–1.29; p˂0.0001). There was a positive interaction between ACR level and history of AMI (HR 1.15; 95%CI 1.03–1.29; p = 0.01) and the presence of heart failure at admission (HR 1.11; 95%CI 1.01–1.24; p = 0.04), and negative interaction with higher than median LVEF (HR 0.89; 95%CI 0.80–0.99; p = 0.03) for all-cause mortality at the multivariable level. Conclusion: Based on the present analysis, baseline urinary albumin excretion during ACS is a strong independent predictor of the very long-term mortality risk, chiefly due to non-sudden cardiac death. Graphical abstract: Nelson-Aalen cumulative hazard estimates for all-cause and causes of death during 22 years of follow-up according to baseline ACR level. ACR= Urinary albumin-to-creatinine excretion ratio (mg/g); non-SCD= non-sudden cardiac death; non-CD= non-cardiac death; SCD= sudden cardiac death. * Values from the Cox regression analysis using a model adjusted for baseline age, gender, smoking, diabetes mellitus, hypertension, history of infarction, presence of heart failure at admission, and plasma total cholesterol level Unlabelled Image Highlights: Microalbuminuria is associated with all-cause mortality in patients with ACS. Little is known about its association with different causes of death. In this study, ACS patients were enrolled and prospectively followed for 22 years. Baseline microalbuminuria is a strong independent predictor only of non-SCD. An independent interaction was found between ACR and indicators of heart failure.