Microalbuminuria as a marker for prediction of early mortality in acute STEMI

Abstract

Background: Microalbuminuria is gaining recognition as a simple and inexpensive marker in predicting cardiovascular mortality and CVD events, independent of traditional risk factors. Microalbuminuria associated with acute MI is attributed to a systemic increase in vascular permeability, including renal vasculature, as part of early anti inflammatory process which accompanies MI. Objectives: To examine whether and how long microalbuminuria increases after acute MI and to report on the predictive power of microalbuminuria for early mortality in these subjects. Methods: OF 175 patients studied, 110 patients had STEMI, 44 had NSTEMI and 21 had unstable angina. Patients having STEMI were taken a study group while patients having NSTEMI and unstable angina were taken as control group. Urinary albumin excretion level (UAEL) was assessed in three sport urinary samples performed on the 1st, 3rd and 7th day. Method used was MICRAL dipstick test. UAEL was expressed in mg/l. Patients with UAEL 20 – 100 mg/l were said to have microalbuminuria. Results: our results showed a marked increase in UAEL in acute phase of STEMI. After an initial rise, urinary albumin levels progressively fell towards normal during the week after admission to the hospital. Significantly elevated UAEL was observed in 52% of STEMI patients especially on day 1 (p=0.000), the subsequent level of UAEL on day 3 (p = 0.384) and day 7 (p = 0.840) equated in proportion to insignificance. Mortality was eventful due to elevated UAEL on day 1, 3 &7 respectively, difference was significant all through (p = 0.001, 0.000, 0.005) respectively. Conclusions: The measurement of UAEL is inexpensive, readily available prognostic index in patients with STEMI. Moreover, UAEL < 20mg/l in the initial days of MI is associated with a low mortality and these patients can be early discharged from hospital