Single spot albumin to creatinine ratio: A simple marker of long-term prognosis in non-ST segment elevation acute coronary syndromes.
BACKGROUND
Microalbuminuria is a known risk factor for cardiovascular morbidity and mortality suggesting that it should be a marker of endothelial dysfunction. Albumin to creatinine ratio (ACR) is an available and rapid test for microalbuminuria determination, with a high correlation with the 24-h urine collection method. There is no prospective study that evaluates the prognostic value of ACR in patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS). The purpose of our study was to detect the long-term prognostic value of ACR in patients with NSTE-ACS.


METHODS
Albumin to creatinine ratio was estimated in 700 patients with NSTE-ACS at admission. Median follow-up time was 18 months. The best cutoff point of ACR for death or acute myocardial infarction was 20 mg/g. Twenty-two percent of patients had elevated ACR.


RESULTS
By multivariable Cox regression analysis, ACR was an independent predictor of the clinical endpoint: odds ratio 5.8 (95% confidence interval [CI] 2-16), log-rank 2 p < 0.0001 in a model including age > 65 years, female gender, diabetes mellitus, creatinine clearance, glucose levels at admission, elevated cardiac markers (troponin T/CK-MB) and ST segment depression. The addition of ACR significantly improved GRACE score C-statistics from 0.69 (95% CI 0.59-0.83) to 0.77 (95% CI 0.65-0.88), SE 0.04, 2 p = 0.03, with a good calibration with both models.


CONCLUSIONS
Albumin to creatinine ratio is an independent and accessible predictor of long-term adverse outcomes in NSTE-ACS, providing additional value for risk stratification.
Coronary Care Unit, Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina. chiga@hospitalaleman.com.
Claudio Cesar
CC
Higa
Fedor Anton
FA
Novo
Ignacio
I
Nogues
Maria Graciana
MG
Ciambrone
Maria Sol
MS
Donato
Maria Jimena
MJ
Gambarte
Natalia
N
Rizzo
Maria Paula
MP
Catalano
Eugenio
E
Korolov
Pablo Dino
PD
Comignani
D054058:Acute Coronary Syndrome / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000175:diagnosis / Q000652:urine*; D001118:Argentina / Q000453:epidemiology; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000652:urine*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
D015415:Biomarkers; D003404:Creatinine
acute coronary syndromes; microalbuminuria; prognosis