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Giuseppe Berton, MD; Tiziana Citro, MD; Rosa Palmieri, MD; Stefania Petucco, MD; Renzo De Toni, DBSc; Paolo Palatini, MD

Background This study was undertaken to assess whether albumin excretion rate (AER) increases during acute myocardial infarction (AMI) and whether it predicts in-hospital mortality.

Methods and Results The study was carried out in 496 subjects admitted to hospital for suspected AMI. Of these, 360 had evidence of AMI. The other 136 were studied as control subjects. AER was assessed by radiocimmunoassay in three 24-hour urine collections performed on the first, third, and seventh days after admission. Left ventricular ejection fraction was measured by two-dimensional echocardiography in 254 subjects. AER adjusted for several confounders was higher in the AMI than the non-AMI group on the first (69.2+5.2 versus 27.3+8.5 mg/24 h, P<.0001) and third (30.3+2.7 versus 12.5+4.4 mg/24 h, P=.001) days, whereas no difference was present on the seventh day. When the subjects with heart failure were excluded, the difference between the two groups remained significant (first day, P<.0001; third day, P=.001). On the basis of classification of the 26 AMI patients who died in hospital according to whether they had normal AER, microalbuminuria, or overt albuminuria, mortality rate pro- gressively increased with increasing levels of AER (P<.0001). In a Cows proportional hazards model, AER was a better predictor of in-hospital mortality than Killip class or echocar- diographic left ventricular ejection fraction. A cutoff value of 50 mg/24 h for first-day AER and 30 mg/24 h for third-day AER yielded a sensitivity of 92.3% and of 88.5% and a specificity of 724% and of 79.3%, respectively, for mortality. Adjusted relative risks for the two cutoff values were 17.3 (confidence limits, 4.6 to 112.7) and 8.4 (confidence limits, 2.4 to 39.3), respectively.

Conclusions These data show that AER increases during AMI and that it yields prognostic information additional to that provided by clinical or echocardiographic evaluation of left ventricular performance.

Circulation 1997; 96:3338-3345.

Keywords myocardial infarction, heart failure, mortality, microalbuminuria

Welcome

In 1992, a small group of medical researchers and other participants embarked on an project to investigate new clinical factors for heart disease, studying patients with acute coronary syndrome and following them for many years. Today, the observations on the long-term survival after acute coronary syndrome are internationally acknowledged. Main results appears on the most important cardiovascular texts across the world. The study is called “the ABC heart disease study”.

Nel 1992, un piccolo gruppo di medici ricercatori ed altri operatori sanitari, iniziarono un progetto per studiare nuovi fattori clinici della malattia cardiaca, studiando pazienti con sindrome coronarica acuta e seguendoli per molti anni. Oggi, ciò che è stato osservato sulla sopravvivenza a lungo temine dopo sindrome coronarica acuta è riconosciuto a livello internazionale. I principali risultati appaiono sui maggiori testi di medicina cardiovascolare in tutto il mondo. Questo progetto è stato chiamato “the ABC heart disease study”.

Mission

The Mission of the ABC Study on Heart Disease Project is to promote the knowledge on heart disease chiefly based on the long-term follow up of the patients. And to promote citizen health supporting preventive, social, and sport activities.