title: Prognostic significance of microalbuminuria in patients with acute myocardial infarction.
abstract: BACKGROUND
  Microalbuminuria has been reported to occur in patients with acute myocardial infarction (AMI) and associated with worse outcome. In our prospective analysis we included patients with AMI with the primary aim to examine whether urinary albumin excretion is increased in those patients and whether it is associated with worse in-hospital prognosis (major complications). The secondary objective was to examine the predictive power of microalbuminuria for 6-month mortality and re-hospitalization for cardiovascular disease.
  
  
  METHODS
  One hundred thirty patients admitted to the Coronary Care Unit were studied prospectively. The diagnosis of myocardial infarction was based on the latest criteria of the European Cardiac Society. Microalbuminuria was defined as a urinary albumin creatinine ratio (UACR) and was measured on the third day after admission in the first morning urine sample.
  
  
  RESULTS
  One hundred thirty patients were enrolled in this study--82 (63.03%) men and 48 (36.92%) women, age 62.48 +/- 12 years. A high proportion of study patients (27.7%) had microalbuminuria and 8.5% had overt albuminuria (UACR over 25 mg/mmol in men and over 35 mg/mmol in women) at the time of urine examination. During the hospital stay (average 7.6 +/- 3.0 days) 4 patients (3.1%) died from cardiovascular complications and all had microalbuminuria. In our study a high percentage of patients with in-hospital nonfatal complications had microalbuminuria but it did not have positive predictive association with the occurrence. During a 6-month follow-up period, 8 patients died from cardiovascular cause. In-hospital and total mortality (in-hospital and the during six-month follow-up) were significantly frequent in patients with microalbuminuria (p < 0.05). During a six-month follow-up period, 24 patients (18.5%) were re-hospitalized for cardiovascular disease and, among them, 54.2% had microalbuminuria. In univariant regression analysis microalbuminuria increased the risk for re-hospitalization, but multiple analysis didn't show the significance.
  
  
  CONCLUSIONS
  We found that UACR measured during the first week after AMI is independently associated with increased long-term risk for in-hospital and six-month mortality. On the basis of these results, we suggest that this measurement should be included in the routine clinical work up of patients with AMI.
authors.affiliation: Clinic for Cardiovascular Diseases, Clinical Centre Nis, Serbia.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Apostolovic
authors.forename: Dragana
authors.initials: D
authors.lastname: Stanojevic
authors.forename: Vidosava
authors.initials: V
authors.lastname: Djordjevic
authors.forename: Ruzica Jankovic
authors.initials: RJ
authors.lastname: Tomasevic
authors.forename: Sonja Salinger
authors.initials: SS
authors.lastname: Martinovic
authors.forename: Danijela Djordjevic
authors.initials: DD
authors.lastname: Radojkovic
authors.forename: Goran
authors.initials: G
authors.lastname: Koracevic
authors.forename: Ivana
authors.initials: I
authors.lastname: Stojanovic
authors.forename: Milan
authors.initials: M
authors.lastname: Pavlovic
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology* / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality / Q000652:urine; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors