Single spot albumin to creatinine ratio: A simple marker of long-term prognosis in non-ST segment elevation acute coronary syndromes.
Cardiol J. 2015 Oct 27;
Authors: Higa CC, Novo FA, Nogues I, Ciambrone MG, Donato MS, Gambarte MJ, Rizzo N, Catalano MP, Korolov E, Comignani PD
BACKGROUND: Microalbuminuria is a known risk factor for cardiovascular morbidity and mortality suggesting that it should be a marker of endothelial dysfunction. Albumin to keratinize ratio (ACR) is an available and rapid test for microalbuminuria determination, with a high correlation with the 24- hour urine collection method. There is no prospective study that evaluates the prognostic value of ACR in patients with Non ST Elevation Acute Coronary Syndromes (NST-ACS). The purpose of our study was to detect the long- term prognostic value of ACR in patients with NST-ACS.
METHODS AND RESULTS: ACR was estimated in seven hundred patients with NST-ACS at admission. Median follow- up time was 18 months. The best cut-off point of ACR for death or acute myocardial infarction was 20 mg/g. Twenty-two percent of patients had elevated ACR. By multivariable Cox regression analysis, ACR was an independent predictor of the clinical end point: OR 5.8 (CI 95% 2-16), log-rank 2 P <0.0001 in a model including age > 65 years, female gender, diabetes mellitus, keratinize 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 (CI 95% 0.59-0.83) and 0.77 (CI 95% 0.65-0.88), SE 0.04, 2 p = 0.03.with a good calibration with both models.
CONCLUSIONS: ACR is an independent and accessible predictor of long-term adverse outcomes in NST-ACS, providing additional value for risk stratification.
PMID: 26503079 [PubMed - as supplied by publisher]