Giuseppe Berton, MD, FESC, Rocco Cordiano, MD, Stefano Mazzuco, PhD, Ethan Katz, MD, Renzo De Toni, PhD, and Paolo Palatini, MD Conegliano, Adria, and Padova, Italy; and Cleveland, OH

Background Albumin excretion rate has been found to be associated with increased risk of mortality in several clinicalsettings. We assessed the relationship between urinary albumin and 7-year mortality in a cohort of patients with acutemyocardial infarction (AMI).

Methods In this prospective study, we examined 505 white patients admitted with AMI to the intensive care unit of3 hospitals. Main end points were nonearly all-cause and cardiovascular (CV) mortality. Albumin-to-creatinine ratio (ACR) was measured by radioimmunoassay on the first, third, and seventh days after admission. Risk estimates were made using Coxproportional-hazard model and relative odds. Forty patients (7.9%) died early inhospital, and 175 (34.7%) died during therest of the follow-up (nonearly mortality).

Results The ACR measured on the third day predicted the occurrence of 7-year nonearly all-cause and CV mortality.Hazard ratios for ACR≥0.97 mg/mmol were 3.0 (95% confidence limit 2.2-4.1),P< .0001, for nonearly all-cause mortalityand 3.5 (95% confidence limit 2.5-5.0),P< .0001, for CV mortality. Correspondent fully adjusted hazard ratios were1.9 (95% CI 1.4-2.6),P< .0001, and 2.2 (95% CI 1.5-3.2),P< .0001, respectively. By adding ACR to the 18-variablepredictive model, ACR improved significantly both the goodness of fitting of the model for nonearly all-cause (P< .0001) andCV mortality (P< .0001) and the C-statistic value (P< .0001 andP= .002 for nonearly all-cause and CV mortality,respectively). Similar results were obtained for ACR measured on the first day or the seventh day.

Conclusions An early increase of urinary albumin in AMI is a strong independent predictor of long-term adverse clinicaloutcome. The ACR improved clinical prediction over and above baseline traditional multivariable risk models.

(Am Heart J2008;156:760-8.)