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