Author + information
- Fedor Novo,
- Claudio Cesar Higa,
- Maria Sol Donato,
- Maria Graciana Ciambrone,
- Jimena Gambarte,
- Natalia Rizzo,
- Ignacio Nogues,
- Maria Paula Catalano,
- Rocio Piccinini,
- Eugenio Korolov and
- Pablo Comignani
Single sample albumin: creatinine ratio (ACR) correlates well with 24 hour collected microalbuminuria. It is a world wide available marker associated with increased risk of mortality in several clinical settings including acute myocardial infarction. Otherwise there is no data regarding the prognostic value of ACR in Non-ST-Segment Elevation Acute Coronary Syndrome. The purpose of our study was to evaluate the long term prognostic value of ACR in patients with Non-ST-Segment Elevation Acute Coronary Syndrome.
We analyzed a prospective cohort of Non-ST-Segment Elevation Acute Coronary Syndrome in whom ACR was determined at admission by inmmuneturbidimetry. Area under the ROC curve was constructed to determine best cut off value associated with primary end-point of death or nonfatal myocardial infarction. Independent variables for the primary end point were assessed by a Cox regression model.
Seven hundred ten patients with Non-ST-Segment Elevation Acute Coronary Syndrome were analyzed. 30% were female and median age was 63 years. Median follow up time was 24 months. Best cut-off point of ACR for primary end point was 20 mg/gr. 34% of patients had ACR above this value. Elevated ACR correlated with higher incidence of primary end point both in diabetics and in non-diabetic patients: OR 3.5 (IC 95 2.3–14), p = 0.001 and OR 5.4 (IC 95% 2.4–11), p= 0.02, respectively. By multivariable Cox regression analysis, ACR was an independent predictor of death or myocardial infarction at long-term follow up: HR 5.8 (CI 95% 2–11), log Rank 2 p <0.0001 in a model that included age, female gender, diabetes mellitus, serum creatinine, creatinine clearance, glucemia at admission, elevated cardiac markers (Troponin T / CK MB) and ST segment deviations. Addition of ACR significantly improved GRACE score C-Statistics from 0.69 and 0.77, p= 0,03.
This simple and accessible marker was an independent predictor of long-term adverse outcomes in Non-ST-Segment Elevation Acute Coronary Syndrome, providing additional value to the GRACE score. ACR should be considered in the future for risk stratification of this large and heterogeneous syndrome.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: The Blood Tells a Story: Coeptin, Fatty Acid Binding Protein, NT-Pro BNP and More
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1259-214
- 2013 American College of Cardiology Foundation