title: Albuminuria and cardiovascular events in patients with acute coronary syndromes: Results from the TRACER trial.
abstract: BACKGROUND
  Albuminuria is associated with cardiovascular (CV) outcomes. We evaluated albuminuria, alone and in combination with estimated glomerular filtration rate (eGFR), as a predictor of mortality and CV morbidity in 12,944 patients with non-ST-segment elevation acute coronary syndromes.
  
  
  METHODS
  Baseline serum creatinine and urinary dipsticks were obtained, with albuminuria stratified into no/trace albuminuria, microalbuminuria (≥30 but <300 mg/dL), or macroalbuminuria (≥300 mg/dL). Kaplan-Meier rates and proportional Cox hazards models of CV death, overall mortality, CV death or myocardial infarction (MI), and bleeding were calculated. Incidence of acute kidney injury, identified by adverse event reporting and creatinine increase (absolute ≥0.3 mg/dL or relative ≥50%), was descriptively reported.
  
  
  RESULTS
  Both dipstick albuminuria and creatinine values were available in 9473 patients (73.2%). More patients with macroalbuminuria, versus no/trace albuminuria, had diabetes (66% vs 27%) or hypertension (86% vs 68%). Rates for CV death and overall mortality per strata were 3.1% and 4.8% (no/trace albuminuria); 5.8% and 9.0% (microalbuminuria); and 7.7% and 12.6% (macroalbuminuria) at 2 years of follow-up. Corresponding rates for CV death or MI were 12.2%, 16.9%, and 23.5%, respectively. Observed acute kidney injury rates were 0.6%, 1.2%, and 2.9% (n = 79), respectively. Adjusted HRs for macroalbuminuria on CV mortality were 1.65 (95% CI 1.15-2.37), and after adjustment with eGFR, 1.37 (95% CI 0.93-2.01). Corresponding HRs for overall mortality were 1.82 (95% CI 1.37-2.42) and 1.47 (95% CI 1.08-1.98).
  
  
  CONCLUSIONS
  High-risk patients with non-ST-segment elevation acute coronary syndromes and albuminuria have increased morbidity and increased overall mortality independent of eGFR.
authors: Duke Clinical Research Institute, Durham, NC; Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala, Sweden. Electronic address: axel.akerblom@ucr.uu.se.
authors: Axel
authors: A
authors: Åkerblom
authors: Duke Clinical Research Institute, Durham, NC.
authors: Robert M
authors: RM
authors: Clare
authors: Duke Clinical Research Institute, Durham, NC.
authors: Yuliya
authors: Y
authors: Lokhnygina
authors: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala, Sweden.
authors: Lars
authors: L
authors: Wallentin
authors: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala, Sweden.
authors: Claes
authors: C
authors: Held
authors: Department of Cardiology, University of Leuven, Leuven, Belgium.
authors: Frans
authors: F
authors: Van de Werf
authors: Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY.
authors: David J
authors: DJ
authors: Moliterno
authors: Duke Clinical Research Institute, Durham, NC.
authors: Uptal D
authors: UD
authors: Patel
authors: Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: Sergio
authors: S
authors: Leonardi
authors: Division of Cardiology, University of Alberta, Edmonton, Canada.
authors: Paul W
authors: PW
authors: Armstrong
authors: Department of Medicine, Stanford University, Stanford, CA.
authors: Robert A
authors: RA
authors: Harrington
authors: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors: Harvey D
authors: HD
authors: White
authors: South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia.
authors: Philip E
authors: PE
authors: Aylward
authors: Department of Medicine, Stanford University, Stanford, CA.
authors: Kenneth W
authors: KW
authors: Mahaffey
authors: Duke Clinical Research Institute, Durham, NC.
authors: Pierluigi
authors: P
authors: Tricoci
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology* / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D003404:Creatinine / Q000097:blood*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D003404:Creatinine