Abstract 16820: Albuminuria and Outcomes in Patients With Non-ST-segment Elevation Acute Coronary Syndromes: Results From the TRACER Trial

Abstract

Introduction: Patients with acute coronary syndromes (ACS) and kidney dysfunction are at increased risk of recurrent cardiovascular (CV) adverse events. Urinary albumin excretion (albuminuria) has been independently associated with CV outcomes. However, in a high-risk population of patients with ACS, the additional prognostic information of albuminuria to estimated glomerular filtration rate (eGFR) is less clear. Hypothesis: We studied the relationship between albuminuria and CV death and myocardial infarction (MI) in 12,944 patients with non-ST-segment elevation (NSTE)-ACS. Methods: Albuminuria was collected routinely at baseline by dipsticks and stratified into no/trace albuminuria, microalbuminuria (≥30mg/dL), and macroalbuminuria (≥300mg/dL). Baseline serum creatinine was obtained. Kaplan-Meier event rates for CV death, and the combination of CV death or MI were calculated. Multivariable adjusted Cox regression models, with baseline characteristics and biomarkers, and the addition of eGFR (Chronic Kidney Disease - Epidemiology (CKD-EPI) equation), were assessed. Results: Levels of albuminuria were available in 9736 patients (75.2%), and both serum creatinine and albuminuria measurements in 9473 (73.2%) patients. More patients with macroalbuminuria, compared with patients with no albuminuria, had diabetes (66% vs. 27%) or hypertension (86% vs. 68%) There was a significant increased risk in CV events with macroalbuminuria, which was significant in the adjusted model but did not remain significant when eGFR was added to the model (Table). Conclusions: High-risk patients with NSTE-ACS and albuminuria at presentation have an increased risk of adverse CV outcomes. However, in the present cohort, albuminuria did not provide additional independent prognostic value to eGFR.