Abstract 13493: Microalbuminuria During Acute Coronary Syndrome: Association With Very Long-Term Mortality and Causes of Death. The ABC-8* Study on Heart Disease

Abstract

Background: Microalbuminuria is associated with adverse outcome in acute coronary syndrome (ACS) patients. Methods: To evaluate the very long-term association between microalbuminuria during ACS and the overall mortality and causes of death, we prospectively studied 579 ACS patients admitted to three Italian 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 the follow-up, representing 6756 person-years. During 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. The unadjusted Cox regression analysis showed that ACR is a significant predictor of all-cause mortality (HR:1.26; 95%CI 1.22-1.31; p˂0.0001) and the 3 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. Yet the fully adjusted model showed that ACR is 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).A positive interaction between ACR and history of AMI (HR:1.15; 95%CI 1.03-1.29; p=0.01), and the presence of heart failure during admission (HR:1.11; 95%CI 1.01-1.24; p=0.04), and a negative interaction with LVEF (HR:0.89; 95%CI 0.80-0.99; p=0.03) for all-cause death was also observed at the multivariable level. Conclusion: This prospective study shows that baseline ACR during ACS seems to be a strong independent predictor of the very long-term mortality risk, chiefly associated with non-sudden cardiac death. A positive independent interaction with indicators of heart failure has been also observed. Figure 1: Relative hazard estimates for all-cause and cause-specific mortality 22 years after ACS according to baseline ACR.