Microalbuminuria during acute myocardial infarction - A strong predictor for 1-year mortality

Aims Urinary albumin excretion increases during acute myocardial infarction but little is known on the prognostic significance and the pathophysiologi cal mechanisms of microalbuminuria in this clinical setting. The primary ai m of the study was to examine whether urinary albumin excretion has predict ive power for 1-year mortality after acute myocardial infarction. A seconda ry objective wets to gain insight into the pathophysiological mechanisms of increased urinary albumin in myocardial infarction. Methods and Results This is a prospective cohort study conducted in three c oronary care units (Northeast Italy). Four hundred and thirty-two unselecte d, consecutively enrolled patients with acute myocardial infarction (66.3 /- 12.3 years of age) were studied. The incidence of mortality was related to the baseline urinary albumin:creatinine ratio. The best cut-off for tota l mortality approximated to 50 mg.g(-1) on the first day after myocardial i nfarction, 30 mg.g(-1) on the third day, and to 20 mg.g(-1) on the seventh day. At multivariable Cox analysis. the albumin:creatinine ratio wits the s trongest among several independent predictors of mortality (adjusted relati ve risks: 3.6 (95% CI, 2.1-6.2) on the first day, 4.9 (95% CI, 2.9-8.2) on the third day and 4.0 (95% CI, 2.3-6.8) on the seventh day). Independent de terminants of urinary albumin were plasma aldosterone on the first day, and inflammatory markers on the third and seventh days, Conclusion Urinary albumin assessed in the first week after acute myocardia l infarction is a strong prognostic marker for 1-year mortality. (Ear Heart J 2001; 22, 1466-1475, doi:10.1053/euhj.2000.2582) ( C) 2001 The European Society of Cardiology.