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Giuseppe Berton, MD,FESC;Rocco Cordiano, MD;Rosa Palmieri, MD;Fiorella Cavuto, MD;Patrizio Buttazzi, PhD; Paolo Palatini, MD

Background: C-reactive protein (CRP) is an established prognostic marker in the setting of acute coronarysyndromes. Recently, albumin excretion rate also has been found to be associated with adverse outcomesin this clinical setting. Our aim was to compare the prognostic power of CRP and albumin excretion rate forlong-term mortality following acute myocardial infarction (AMI).

Hypothesis: To determine whether albumin excretion rate is a better predictor of long-term outcome than CRPin post-AMI patients.Methods:We prospectively studied 220 unselected patients with definite AMI (median [interquartile] age67 [60–74] y, female 26%, heart failure 39%). CRP and albumin-to-creatinine ratio (ACR) were measured onday 1, day 3, and day 7 after admission in 24-hour urine samples. Follow-up duration was 10 years for allpatients.

Results: At survival analysis, both CRP and ACR were associated with increased risk of 10-year all-causemortality, also after adjusting for age, hypertension, diabetes mellitus, prehospital time delay, creatinekinase-MB isoenzyme peak, heart failure, and creatinine clearance. CRP and ACR were associated withnonsudden cardiovascular(non-SCV) mortality but not with sudden death (SD) or noncardiovascular(non-CV)death. CRP was not associated with long-term mortality, while ACR was independently associated withoutcome both in short- and long-term analyses. At C-statistic analysis, CRP did not improve the baselineprediction model for all-cause mortality, while it did for short-term non-SCV mortality. ACR improved all-causeand non-SCV mortality prediction, both in the short and long term.

Conclusions: ACR was a better predictor of long-term mortality after AMI than CRP.