Comparison of C‐reactive Protein and Albumin Excretion as Prognostic Markers for 10‐Year Mortality After Myocardial Infarction

Abstract

Background: C-reactive protein (CRP) is an established prognostic marker in the setting of acute coronary syndromes. Recently, albumin excretion rate also has been found to be associated with adverse outcomes in this clinical setting. Our aim was to compare the prognostic power of CRP and albumin excretion rate for long-term mortality following acute myocardial infarction (AMI). Hypothesis: To determine whether albumin excretion rate is a better predictor of long-term outcome than CRP in post-AMI patients. Methods: We prospectively studied 220 unselected patients with definite AMI (median [interquartile] age 67 [60][61][62][63][64][65][66][67][68][69][70][71][72][73][74] y, female 26%, heart failure 39%). CRP and albumin-to-creatinine ratio (ACR) were measured on day 1, day 3, and day 7 after admission in 24-hour urine samples. Follow-up duration was 10 years for all patients.Results: At survival analysis, both CRP and ACR were associated with increased risk of 10-year all-cause mortality, also after adjusting for age, hypertension, diabetes mellitus, prehospital time delay, creatine kinase-MB isoenzyme peak, heart failure, and creatinine clearance. CRP and ACR were associated with nonsudden 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 with outcome both in short-and long-term analyses. At C-statistic analysis, CRP did not improve the baseline prediction model for all-cause mortality, while it did for short-term non-SCV mortality. ACR improved all-cause and 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.

Prognostic Value of Chronic Kidney Disease Measures in Patients With Cardiac Disease

“…100 As with the tools for MI patients, most of the prediction tools for HF patients are derived from North American and European data and also target death as an outcome with a short time frame for risk prediction (≤1 year) ( Table 4). Reported risk discrimination (i.e., c-statistic) ranges from 0.70 to 0.87.…”

Eicosapentaenoic and Docosahexaenoic Acids Attenuate Progression of Albuminuria in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease

“…Moreover, urine albumin‐to‐creatinine ratio (ACR) <30 μg/mg, which has generally been considered in the normal range, has been shown to predict incident hypertension and cardiovascular disease mortality at 11‐year follow‐up in subjects who were healthy and nondiabetic at baseline . Furthermore, albuminuria is a better predictor for long‐term mortality after acute myocardial infarction than C‐reactive protein (hazard ratio: 1.8; 95% CI, 1.1–3.1 for albuminuria versus 1.1; 95% CI, 0.7–1.8 for C‐reactive protein) …”

Association between Microalbuminuria Predicting In-Stent Restenosis after Myocardial Infarction and Cellular Senescence of Endothelial Progenitor Cells

“…For example, in this study, the level of hsCRP was significantly higher in the microalbuminuria group. Though we could not show the direct correlation between hsCRP and EPC mobilization, hsCRP is known to be a circulating inflammatory marker that reflects systemic vascular damage, and considered to be an independent cardiovascular risk factor as well as microalbuminuria [ 24 , 25 ]. Recently, Ling et al showed that the number of circulating-EPCs presented a greater increase in AMI patients with diabetes mellitus (DM) than in AMI patients without DM [ 13 ].…”