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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

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.