Incidence of fatal stroke 24 years after acute coronary syndrome: the value of baseline albuminuria and hypertension. The ABC study on acute coronary syndrome

Abstract

Abstract Background Albuminuria and hypertension are known independent predictors of stroke risk. Purpose To investigate the additive effect of baseline albuminuria and hypertension on the very long-term risk prediction of fatal stroke (FS) in patients with acute coronary syndrome (ACS). Methods The present analysis includes 589 patients admitted with ACS to 3 Italian hospitals and discharged alive. Patients were followed prospectively for 24 years or until death. Baseline clinical and laboratory data were recorded within the first 7 days of hospitalization. Results All but three patients completed the follow-up representing 7065 person-years and 44 patients (7%) developed FS. They shared most of the baseline clinical characteristics with the patients who did not have FS, except for being significantly older (mean age was 72±8 vs. 66±12 years, p=0.0008). Patients with FS also had albuminuria more frequently (66% vs. 49%, p=0.03) with significantly higher values of 3rd-day albumin–creatinine ratio (ACR), (p=0.009). At Cox regression analysis; patients who had hypertension or albuminuria had a higher risk of developing FS, hazard ratios were (HR=1.8; 95%CI=1.0–3.2; p=0.05 and HR=2.9; 95%CI=1.5–5.3; p=0.001 respectively. Patients with both hypertension and albuminuria showed an independent risk association for developing FS than patients with neither HR=4.2; 95%CI=1.8–9.7; p=0.001. Results kept true with a model adjusted for age, gender and presence of atrial fibrillation. The same results were obtained with the competing risk analysis (HR=2.6; 95%CI=1.1–6.0, p=0.02). Conclusions the results showed that the combination of hypertension and albuminuria is associated with an independent greater risk of developing a fatal stroke long after ACS.