Single Spot Albumin to Creatinine Ratio as An Independent Predictor of 12 Years Follow-Up Mortality in Acute Coronary Syndromes without ST-Segment Elevation
Main Article Content
Abstract
Background: Up to date there is no evidence of the association between microalbuminuria, measured as single spot urine albumin to creatinine ratio (ACR), with very long-term mortality in patients with non-ST segment Elevation Acute Coronary Syndromes.
Aim: To evaluate the association between admission ACR and very long-term all-cause mortality in an unselected cohort of non-ST-segment elevation acute coronary syndromes patients.
Methods: A prospective cohort study was conducted, including patients with non-ST-segment elevation acute coronary syndromes admitted in the Intensive Care Unit. The ACR was determined in spontaneous urine samples during the first 24 hours after admission and analyzed by immunoturbidimetry. The primary endpoint was all-cause mortality during the follow-up. Actuarial survival curves were compared by log rank test and a logistical Cox regression analysis was performed to identify variables independently associated with mortality in the follow-up. Statistics were calculated using the IBM Statistics program SPSS version 26.
Results: 600 patients were analyzed. The overall average ACR value was 7 mg/gr (95% CI 4-26). 76% had normoalbuminuria (ACR 0-30 mg/gr), 22% had microalbuminuria (ACR 30-300 mg/gr), and 1.5% had macroalbuminuria (ACR > 300 mg/gr). The median and interquartile range of follow-up was 12 years (95% IC 11-14). The average ACR among those who met the primary endpoint was 59.15 mg/gr (95% CI 52-66) and among the survivors, 27.66 mg/gr (95 % CI 63-77), p > 0,003. ACR terciles were defined by 33th and 66th percentiles: tercile 1: patients with ACR of 0 to 4 mg/gr, tercile 2: ACR from 4 to 17 mg/g and tercile 3 values greater than 17mg/gr. Strong associations were observed between ACR with age, hypertension, stroke and history of COPD, previous use of angiotensin II converter/blocking enzyme inhibitors, systolic blood pressure at admission, ST segment deviation, left ventricle ejection fraction and elevation of serum Troponin T and CPK MB. All cause-mortality during the follow-up was 14% (CI 95% 11-17). Elevation of ACR was significantly associated with long term mortality risk: log rank test chi square: 133.936, p = 0.0001. By multivariate Cox regression analysis adjusted by age, gender, diabetes, hypertension, serum creatinine, troponin T elevation, ST segment deviation, previous AMI, prior use of aspirin, statins and percutaneous coronary intervention after hospitalization, the ACR was independently associated with a 12-year follow-up mortality: OR 13 (95% IC 5-35; p < 0.0001).
Conclusion: Single spot urine ACR at admission is a strong predictor of 12-year follow-up mortality in an unselected cohort of patients with non-ST-segment elevation acute coronary syndromes.
Keywords:
microalbuminuria, acute coronary syndrome, prognosis, follow-up study
Article Details
How to Cite
HIGA, Claudio C. et al.
Single Spot Albumin to Creatinine Ratio as An Independent Predictor of 12 Years Follow-Up Mortality in Acute Coronary Syndromes without ST-Segment Elevation.
Medical Research Archives, [S.l.], v. 11, n. 9, oct. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4378>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i9.4378.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
2. Roffi M, Patrono C, Collet JP et al ESC Scientific Document Group. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-seg¬ment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Pre¬senting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016 Jan 14;37(3):267-315. doi: 10.1093/eurheartj/ehv320. Epub 2015 Aug 29. PMID: 26320110.
3. Reriani MK, Lerman LO, Lerman A. Endothelial function as a functional expression of cardio-vascular risk factors. Biomark Med. 2010 Jun;4(3):351-60. doi: 10.2217/bmm.10.61. PMID: 20550469; PMCID: PMC2911781
4. Gimbrone MA Jr, García-Cardeña G. Endothe¬lial Cell Dysfunction and the Pathobiology of Atherosclerosis. Circ Res. 2016 Feb 19;118(4):620-36. doi: 10.1161/CIRCRESAHA.115.306301. PMID: 26892962; PMCID: PMC4762052Granger CB, Goldberg RJ, Dabbous O et al.; for the Global Registry of Acute Coronary Events In-vestigators. Predictors of hospital morbidity in the global registry of acute coronary events. Arch Intern Med, 2003; 163: 2345–2353
5. Basha BJ, Sowers JR. Atherosclerosis: an up-date. Am Heart J. 1996 Jun;131(6):1192-202. doi: 10.1016/s0002-8703(96)90096-4. PMID: 8644600
6. Ibanez B, James S, Agewall S, Antunes MJ, Buc¬ciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kas¬trati A, Lenzen MJ, Prescott E, Roffi M, Valgim¬igli M, Varenhorst C, Vranckx P, Widimský P; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myo¬cardial infarction in patients presenting with ST-segment elevation: The Task Force for the man¬agement of acute myocardial infarction in pa¬tients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119-177. doi: 10.1093/eurheartj/ehx393.
PMID: 28886621.
7. Granger CB, Goldberg RJ, Dabbous O et al.; for the Global Registry of Acute Coronary Events Investigators. Predictors of hospital mor-bidity in the global registry of acute coronary events. Arch Intern Med, 2003; 163: 2345–2353
8. Bhatt D L, Lopes R D, Harrington R A (2022). Diagnosis and treatment of acute coronary syn¬dromes: A review. JAMA: The Journal of the American Medical Association, 327(7), 662. https://doi.org/10.1001/jama.2022.0358
9. Collet, JP, Thiele H, Barbato E et al. ESC Guide¬lines for the management of acute coronary syndromes in patients presenting without persis¬tent ST-segment elevation. European Heart Journal, 42(14), 1289–1367. https://doi.org/10.1093/eurheartj/ehaa575
10. Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A. Albuminuria re¬flects under-spread vascular damage: the steno hypothesis. Diabetologia, 1989; 32: 219–226
11. Liu H, Zhang J, Yu J, Li D et al. Prognostic value of serum albumin-to-creatinine ratio in patients with acute myocardial infarction: Results from the retrospective evaluation of acute chest pain study. Medicine, 99(35), e22049. https://doi.org/10.1097/MD.0000000000022049
12. Jensen JS, Clausen P, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B. Detecting microalbuminu¬ria by urinary albumin/keratinize concentration ratio. Nephrol Dial Transplant, 1997; 12S2: 6–9.
13. Valmadrid CT, Klein R, Moss SE, Klein BE. The risk of cardiovascular disease morbidity associ¬ated with microalbuminuria and gross pro¬teinuria in persons with older-onset diabetes mellitus. Arch Intern Med, 2000; 160: 1093–1100.
14. Dogra G, Rich L, Stanton K, Watts Parving H. Microalbuminuria in essential hypertension and diabetes. J Hypertens, 1996; 14: S89–S94.
15. Estacio RO, Dale RA, Schrier R, Krantz MJ. Re-lation of reduction in urinary albumin excretion to ten-year cardiovascular mortality in patients with type 2 diabetes and systemic hyperten¬sion. Am J Cardiol, 2012; 109: 1743–1748.
16. Horner P. Fliser D, Klimm HP, Ritz E. Albuminuria in normotensive and hypertensive attending of¬fices of general practitioners. J Hypertens, 1995; 14: 655–660
17. Janssen WM, de Jong PE, de Zeeuw D. Hyper-tension and renal disease: role of microalbumi-nuria. J Hypertens Suppl. 1996 Dec;14(5):S173-7. PMID: 9120675.
18. Marre M. Microalbuminuria and prevention of renal insufficiency and cardiovascular diseases. Am J Hypertens. 1998 Jul;11(7):884-6. doi: 10.1016/s0895-7061(98)00077-6. PMID: 9683055.
19. Zhang Y, Yang J, Zheng M et al. Clinical char-acteristics and predictive factors of subclinical diabetic nephropathy. Exp Clin Endocrinol Dia¬betes. 2015 Feb;123(2):132-8. doi: 10.1055/s-0034-1396810. Epub 2015 Jan 21. PMID: 25607340.
20. Heart Outcomes Prevention Evaluation Study In¬vestigators. Effects of ramipril on cardiovascu¬lar and microvascular outcomes in people with diabetes mellitus: Results of the HOPE study and MICRO HOPE sub-study. Lancet, 2000; 355: 253–259.
21. Gosling P, Hughes EA, Reynolds JP, Fox JP. Mi¬croalbuminuria is an early response following acute myocardial infarction. Eur Heart J, 1991; 12: 508–513.
22. Taskiran M, Feldt-Rasmussen B, Jensen GB, Jen¬sen JS. Urinary albumin excretion in hospital¬ized patients with acute myocardial infarction. Prevalence of microalbuminuria and correlation to left ventricle wall thickness. Scand Cardio¬vasc J, 1998; 32: 163–166.
23. Berton G, Citro T, Palmieri R, Petucco S, De Toni R, Palatini P. Albumin excretion rate increases during acute myocardial infarction and strongly predicts early mortality. Circulation, 1997; 96: 3338–3345
24. Berton R, Cordiano R, Palmieri F, Cucchini R, De Toni R, Palatini P. Microalbuminuria during acute myocardial infarction. A strong predictor for 1-year morbidity G. Eur Heart J, 2001; 22: 1466–1475.
25. Turkyilmaz, E, Ozkalayci F, Birdal O et al. Se-rum albumin to creatinine ratio and short-term clinical outcomes in patients with ST-elevation myocardial infarction. Angiology, 73(9), 809–817. https://doi.org/10.1177/00033197221089423.
26. Bandyopadhyay SK, Ghosh S, Bandyopadh-yay R, Ghosh S, Sarkar N (2010) Microalbumi¬nuria: a predictor of 7-day mortality in acute myocardial infarction. J Indian Med Assoc 108:826–828
27. Higa CC, Novo FA, Nogues I et al. Single spot albumin to creatinine ratio: A simple marker of long-term prognosis in non-ST segment eleva-tion acute coronary syndromes. Cardiol J. 2016;23(3):236-41. doi: 10.5603/CJ.a2015.0075. Epub 2015 Oct 27. PMID: 26503079.
28. Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Re-definition of Myocardial Infarction. Universal definition of myocardial
29. infarction. J Am Coll Cardiol. 2007 Nov 27;50(22):2173-95. doi:
30. 10.1016/j.jacc.2007.09.011. PMID: 18036459.
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