Abstract 571: Prognostic Value of Albuminuria on One Month Mortality in Acute Myocardial Infarction
Background: Albuminuria is associated with hypertension, renal and endothelial dysfunction, inflammation, insulin resistance and atherogenic lipid profile. An increase in albuminuria occurs in the early days after acute myocardial infarction. The aim of this study was to assess the relation between albuminuria and 30 day mortality, as well as its incremental predictive value on top of established prognostic parameters.
Methods: Demographic, clinical and biological characteristics at admission, in-hospital treatments and one month survival were recorded in 1188 consecutive patients admitted for acute myocardial infarction. Albuminuria was assessed from an 8-hour, overnight urine collection at day 3 using immunonephelemetry. The population was categorized according to albuminuria <20, 20 to 200 and >200 μg/min.
Results: Fifty one percent (625/1188) of patients had an albuminuria level below 20 μg/min, 40% (296) between 20 and 200 μg/min and 9% (109) above 200 μg/min. High levels of albuminuria were associated with older age, history of hypertension, previous surgical coronary revascularization, stroke or peripheral vessel disease. Albuminuria was also correlated with troponin release, BNP and high sensitive CRP. At one month, there was a significantly higher mortality rate in groups with higher albuminuria (31/635(5%), 64/477(13%) and 22/109(20%) for albuminuria <20, 20–200 and >200 μg/min respectively). Multivariable analysis showed that albuminuria was an independent predictor of mortality. After adjustment on the GRACE risk score and the use of guidelines-recommended treatments, patients with albuminuria >20 μl/min had a 4-fold higher 30 day mortality, and those >200 μl/min had a 5 fold higher 30 day mortality, as compared with patients with albuminuria <20 μl/min (OR 4 [1.3–12.5] and 5.9 [1.64–20] for albuminuria >20 μl/min and >200 μl/min respectively).
Conclusions: Albuminuria level is an independent and powerful predictor of mortality after acute myocardial infarction.