G. Berton· R. Cordiano· R. Palmieri· R. De Toni· G. L. Guarnieri· P. Palatini

Aims/hypothesis.Diabetes  mellitus  is  associated  withincreased  mortality  in  subjects  with  acute  myocardialinfarction  (AMI).  We  aimed  to  estimate  the  risk  ofmortality  in  AMI  patients  with  and  without  diabetesusing the urinary albumin : creatinine ratio (ACR).

Methods.This  is  a  prospective  study  of  121  consecu-tive, non-selected diabetic AMI patients, 121 age- andsex-matched non-diabetic AMI patients and 61 diabet-ic  non-AMI  outpatients  as  control  subjects.  All  datawere obtained during the first 7 days of hospitalisationand each AMI patient was followed for a period of ex-actly 3 years. Baseline ACR RIA measurements weremade on the 1st, 3rd and 7th days of admission.

Results.Adjusted   ACR   values   were   significantlyhigher in the diabetic AMI patients than in the diabet-ic  control  outpatients  (p<0.0001),  and  a  significant difference  was  observed  between  the  weekly  ACR slopes  for  these  two  groups  (p<0.0001).  Microalbu-minuria  was  more  prevalent  in  the  diabetic  AMI  pa-tients than in the non-diabetic AMI patients on the 1st day (62% vs 46%,p=0.01) and 3rd day (41% vs 29%,p=0.04).  Among  the  AMI  patients  with  normoalbu-minuria  (ACR  <30  μg/mg),  the  mortality  rate  was11.6% for the patients without diabetes and 33.8% forthose with diabetes (p=0.001). The mortality rate wasmuch higher among the AMI patients with microalbu-minuria (ACR ≥30 μg/mg) and similar for the diabetic(68.0%) and non-diabetic patients (74.3%). In a multi-variable  Cox  model,  ACR  (p<0.0001)  and  diabetesstatus (p=0.01) were associated with adverse outcomeeven  when  several  other  clinical  variables  were  in-cluded  in  the  model.  Furthermore,  a  negative  interac-tion was found between diabetes and ACR (p=0.01).

Conclusions/interpretation.Microalbuminuria frequent-ly  occurs  in  diabetic  and  non-diabetic  AMI  patientsduring  the  first  3  days  of  admission  to  hospital  andcan  be  used  to  identify  subjects  at  high  risk  of  mortality.

Keywords. Acute myocardial infarction · Albumin :creatinine ratio · Albumin excretion · Diabetes mellitus · Microalbuminuria · Mortality