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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.)

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.