P442 BASELINE ALBUMINURIA AND HEART FAILURE DURING HOSPITALIZATION WITH ACS AND LONG–TERM DEATH RISK. RESULTS FROM 24 YEARS OF FOLLOW–UP OF THE ABC STUDY ON HEART DISEASE

Abstract

Abstract Background Both albuminuria and heart failure are known predictors of poor outcomes in patients with acute coronary syndrome (ACS). Purpose: To assess the combined effect of albuminuria and heart failure on the long–term mortality risk prediction 24 years after ACS. Methods The present analysis includes 589 patients with ACS admitted to three Italian hospitals and discharged alive. Baseline clinical and laboratory data were collected within the first 7 days of hospitalization. Patients were followed for 24 years or until death. Results Virtually all patients completed the follow–up, representing 7066 person–years. Patients‘ mean age was 66 ± 12 years, 70% were males and 482(82%) had died during follow–up. Compared to those who survived, dead patients, were significantly different for many clinical features, they had baseline HF and microalbuminuria more frequently (39 % vs. 5% p<0.0001) and (24 % vs. 7% p<0.0001), respectively, and they showed significantly higher values of 3rd–day albumin–creatinine ratio (ACR) (p<0.0001). The unadjusted Cox regression analysis showed that the presence of either albuminuria or HF at admission with ACS is independently associated with long–term mortality (HR:1.84; 95%CI 1.54–2.20; p<0.0001) and (HR:2.48; 95%CI 2.05–2.98; p<0.0001), respectively. Results were similar using the fully adjusted model. Moreover, patients who suffered from both pathologies were at higher risk of death than patients with either. Conclusions The Presence of heart failure and albuminuria during ACS is independently associated with long–term mortality with an additive effect.