title: Comparison of C-reactive protein and albumin excretion as prognostic markers for 10-year mortality after myocardial infarction.
abstract: BACKGROUND
  C-reactive protein (CRP) is an established prognostic marker in the setting of acute coronary syndromes. Recently, albumin excretion rate also has been found to be associated with adverse outcomes in this clinical setting. Our aim was to compare the prognostic power of CRP and albumin excretion rate for long-term mortality following acute myocardial infarction (AMI).
  
  
  OBJECTIVE
  To determine whether albumin excretion rate is a better predictor of long-term outcome than CRP in post-AMI patients.
  
  
  METHODS
  We prospectively studied 220 unselected patients with definite AMI (median [interquartile] age 67 [60-74] y, female 26%, heart failure 39%). CRP and albumin-to-creatinine ratio (ACR) were measured on day 1, day 3, and day 7 after admission in 24-hour urine samples. Follow-up duration was 10 years for all patients.
  
  
  RESULTS
  At survival analysis, both CRP and ACR were associated with increased risk of 10-year all-cause mortality, also after adjusting for age, hypertension, diabetes mellitus, prehospital time delay, creatine kinase-MB isoenzyme peak, heart failure, and creatinine clearance. CRP and ACR were associated with nonsudden cardiovascular (non-SCV) mortality but not with sudden death (SD) or noncardiovascular (non-CV) death. CRP was not associated with long-term mortality, while ACR was independently associated with outcome both in short- and long-term analyses. At C-statistic analysis, CRP did not improve the baseline prediction model for all-cause mortality, while it did for short-term non-SCV mortality. ACR improved all-cause and non-SCV mortality prediction, both in the short and long term.
  
  
  CONCLUSIONS
  ACR was a better predictor of long-term mortality after AMI than CRP.
authors: Department of Cardiology, Conegliano General Hospital, Conegliano, Italy.
authors: Giuseppe
authors: G
authors: Berton
authors: Rocco
authors: R
authors: Cordiano
authors: Rosa
authors: R
authors: Palmieri
authors: Fiorella
authors: F
authors: Cavuto
authors: Patrizio
authors: P
authors: Buttazzi
authors: Paolo
authors: P
authors: Palatini
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000401:mortality* / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D002097:C-Reactive Protein / Q000652:urine*; D002423:Cause of Death; D016009:Chi-Square Distribution; D003404:Creatinine / Q000652:urine; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000652:urine*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D003404:Creatinine