Background: Both albuminuria and heart failure are known predictors of poor outcomes in patients with acute coronary syndrome (ACS).
Purpose: To assess the combined effect of albuminuria and heart failure on the long-term mortality risk prediction 24 years after ACS.
Methods: The present analysis includes 589 patients with ACS admitted to three Italian hospitals and discharged alive. Baseline clinical and laboratory data were collected within the first 7 days of hospitalization. Patients were followed for 24 years or until death.
Results: Virtually all patients completed the follow-up, representing 7066 person-years. Patients' mean age was 66 ± 12 years, 70% were males and 482(82%) had died during follow-up. Compared to those who survived, dead patients, were significantly different for many clinical features, they had baseline HF and microalbuminuria more frequently (39 % vs. 5% p<0.0001) and (24 % vs. 7% p<0.0001), respectively, and they showed significantly higher values of 3rd-day albumin-creatinine ratio (ACR) (p<0.0001).
The unadjusted Cox regression analysis showed that the presence of either albuminuria or HF at admission with ACS is independently associated with long-term mortality (HR:1.84; 95%CI 1.54-2.20; p˂0.0001) and (HR:2.48; 95%CI 2.05-2.98; p˂0.0001), respectively. Results were similar using the fully adjusted model.
Moreover, patients who suffered from both pathologies were at higher risk of death than patients with either.
Conclusions: The Presence of heart failure and albuminuria during ACS is independently associated with long-term mortality with an additive effect.