Microalbuminuria: A Strong Predictor of 3-Year Adverse Prognosis in Nondiabetic Patients With Acute Myocardial Infarction

Spyridon Koulouris, MD, PhD; Ioannis Lekatsas, MD, PhD; Ilias Karabinos, MD, PhD; Georgios Ioannidis, MD, PhD; Theofanis Katostaras, PhD; Athanasios Kranidis, MD, PhD; Konstantinos Triantafillou, MD; Nikolaos Thalassinos, MD, PhD; Lambros Anthopoulos, MD, PhD

Disclosures

Am Heart J. 2005;149(5):840-845. 

In This Article

Abstract and Introduction

Background: The aim of this study is to evaluate the significance of microalbuminuria (MA) as a 3-year prognostic index in nondiabetic patients with acute myocardial infarction (AMI).
Methods: One hundred seventy-five patients with AMI were followed prospectively for 3 years. The study end point was cardiac death or rehospitalization for an acute coronary event.
Results: Forty-two patients (24%) developed a new cardiac event during the follow-up. Microalbuminuria ( P < .001), pulmonary edema during initial hospitalization ( P < .001) and postinfarction angina ( P = .0364), advanced age ( P = .001), severe atherosclerosis (high Gensini score) ( P = .036), ejection fraction <50% ( P = .0013), history of bypass surgery ( P = .0265), and early conservative management ( P = .0214) were all associated with adverse prognosis. Cox proportional hazards regression analysis showed that MA was an independent predictor of 3-year adverse prognosis in all the models tested, with an adjusted relative risk for the development of a cardiac event ranging from 2.1 to 4.3.
Conclusions: In nondiabetic patients with AMI, MA is a strong and independent predictor of an adverse cardiac event within the next 3 years.

Microalbuminuria (MA) or dipstick-negative albuminuria, defined as persistent elevation of albumin in the urine of 30 to 300 mg/d or 20 to 200 μg/min, is an established risk factor for renal disease progression in both type 1[1,2] and type 2 diabetes mellitus.[3] In addition, a number of studies suggest that MA defines a group at high risk of increased cardiovascular morbidity and mortality among patients with diabetes[4,5,6] as well as among patients with essential hypertension.[7] Moreover, MA has been closely linked to insulin resistance,[8] and for this reason, it that has been included into the World Health Organization definition of the metabolic syndrome.[9] Finally, MA has been associated with increased cardiovascular morbidity and mortality even in nondiabetic nonhypertensive populations.[10,11]

Recently, it was suggested that MA, assessed in the first week after acute myocardial infarction (AMI), is a strong predictor of both inhospital[12] and 1-year mortality.[13] However, it is not known whether MA remains a significant mortality index even after the first year postmyocardial infarction. Moreover, the significance of this index for the long-term prognosis of a recurrent cardiovascular event or death in a pure nondiabetic population has not been demonstrated so far.

To further delineate the role of MA as an independent risk marker of late morbidity and mortality in patients with AMI, we report the results of a 3-year survival analysis in a sample of patients without diabetes admitted in our coronary care unit for AMI.

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