Existence of microalbuminuria during evolution of acute coronary syndrome is a powerful short-term and long-term prognostic factor

Introduction

Microalbuminuria (MA) is considered a risk factor in the hypertensive and diabetic population. The presence of MA during the evolution of acute coronary syndrome (ACS) is a bad prognosis criterion.

Methods

We studied the presence of MA by 24-hour urine test in 396 hospitalized patients with ACS consecutively. During their hospitalization period blood samples were taken in the first 24 hours for all of them (leukocyte recount, hemoglobin and hematocrit levels, troponin I, total cholesterol, LDL-cholesterol, fibrinogen, ultrasensible C-reactive protein (US-CRP), glucose and glycosylated hemoglobin (HbA1) serum levels). The left ventricular function was determined in all cases through echocardiography. We made a follow-up of 2.5 years.

Results

One hundred and forty-seven patients presented MA (37%). We found this group was also the one with older age (P = 0.001), higher hypertension level (P = 0.001) and more diabetes (P = 0.0001), strokes (P = 0.04), periferal arteriopathy (P = 0.0001) and chronic renal failure (P = 0.0001) cases. Thirty-seven percent of patients were hospitalized in Killip >I stage (P = 0.0001). This group was characterized to have poor left ventricular ejection function (51% vs 46%, P = 0.001), worse renal function (P = 0.001) and higher glycemic levels (P = 0.0001). Patients with MA presented a high intrahospital mortality ratio (9% vs 4%; P = 0.004), more heart failure development (45% vs 21%; P = 0.0001), atrial fibrillation (25% vs 12%; P = 0.004), abnormalities of conduction syndromes (15% vs 7%; P = 0.02), and strokes (4% vs 1%; P = 0.02). In the follow-up, the mortality rate in the MA group rose to 15% (P = 0.0001). In the multivariant analysis due to age, gender, left ventricular ejection function, troponin-I serum levels, existence of anemia and creatinine clearance, MA was found to be an independent risk factor of heart failure (OR = 1.75; 95% CI = 1.02–3.01; P = 0.04) and of mortality (OR = 2.6; 95% CI = 1.05–6.41).

Conclusion

The presence of MA during evolution of ACS is associated with high-profile vascular risk and is a powerful short-term and long-term prognostic factor.