P204 FRACTIONAL EXCRETION OF ALBUMIN DURING ACS AS A PREDICTOR OF THE VERY LONG–TERM MORTALITY AND CAUSES OF DEATH. RESULTS FROM 22 YEARS OF FOLLOW–UP OF THE ABC STUDY ON HEART DISEASE

Abstract Introduction Several clinical risk predictors have been used to stratify risk in acute coronary syndromes (ACS) patients. Yet, few have been tested or demonstrated usefulness in the very long–term follow–up. Purpose To investigate the association between baseline albumin fractional excretion (AlbFE) and the long–term mortality and causes of death after ACS. Methods This prospective analysis included 579 patients admitted with ACS to 3 hospitals and discharged alive. Clinical and laboratory data were gathered within the first 7 days of hospitalization. Baseline AlbFE calculated as ((Serum Cr*Urine Alb) / (Serum Alb*UCr)) %, Patients were followed–up for 22 years. Results All except three patients completed the follow–up, and by its end 449(78%) patients were dead. Causes of death were sudden cardiac death (SCD) in 85(15%), non–sudden cardiac death (non–SCD) in 176(30%), non–cardiac death (non–CD) in 166 (29%). Baseline AlbFE median (IQR) values were: 4.1% (1.5–12.4), 1.7% (0.8–5.3), 1.3% (0.6–3.5) at 1st,3rd, and 7th hospitalization, respectively. At cox regression analysis, 3rd day AlbFE was associated to all–cause mortality: (HR = 1.4, 95%CI=1.3–1.5; p < 0.0001). It was also associated to the risk of non–SCD (HR = 1.6, 95%CI=1.4–1.7; p < 0.0001), SCD (HR = 1.3, 95%CI=1.2–1.5; p < 0.0001), and to non–CD (HR = 1.3, 95%CI=1.1–1.4; p < 0.0001). Using a cox regression model adjusted for age, gender diabetes and baseline left ventricular ejection fraction: the 3rd day AlbFE was associated to all–cause mortality (HR = 1.1, 95%CI=1.1–1.2; p < 0.0001), and to non–SCD risk (HR = 1.2, 95%CI=1.1–1.4; p < 0.0001) but not to the risk of SCD or non–CD (HR = 1.1, 95%CI=0.9–1.2; p = 0.45), and (HR = 1.1, 95% CI=1.0–1.2; p = 0.06), respectively. Same results were obtained with 1st an 7th day AlbFE values. Of relevance, a sub–analysis showed that the association between the 3rd day AlbFE and all–cause mortality kept true both in the 1st (1–11 years) and the 2nd (12–22 years) half of follow up period; (HR = 1.5, 95%CI=1.4–1.6; p < 0.0001) and (HR = 1.2, 95%CI=1.1–1.4; p = 0.001) in the unadjusted model and (HR = 1.3, 95%CI=1.2–1.4; p < 0.0001) and (HR = 1.1, 95%CI=1.0–1.3; p = 0.02) in age and gender–adjusted model for the 1st and the second half respectively. Conclusion The present results showed that baseline AlbFE is an independent predictor of mortality up to 22 years after ACS, chiefly for non–SCD.