Key result
Elevated ACR linked to ~10-fold higher long-term mortality in NSTEACS.
Why the study?
Does the albumin-to-creatinine ratio (ACR) predict long-term mortality in diabetic and non-diabetic patients with NSTEACS?
Cohort (n=600)
No
Does the albumin-to-creatinine ratio (ACR) predict long-term mortality in diabetic and non-diabetic patients with NSTEACS?
Odds Ratio: 10.12 (95% CI 9.91–13.34)
p-value: p=0.005
Microalbuminuria, measured by the albumin-to-creatinine ratio within 24 hours of admission, is a strong independent predictor of long-term mortality in both diabetic and non-diabetic patients with NSTEACS.
Introduction Albumin-to-creatinine (ACR) ratio as an expression of microalbuminuria is an independent predictor of cardiovascular events in diabetic patients and also a marker of mortality in acute coronary syndromes. Objectives To analyze the predictive capacity of ACR as a predictor of long-term mortality in diabetic versus non-diabetic patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Material-Methods A prospective cohort study was performed, including consecutively patients with a diagnosis of NSTEACS admitted to the Intensive Care Unit of a Community Hospital. ACR was determined in spontaneous urine samples during the first 24 hours after admission and analyzed by immunoturbidimetry. Patients with previous diuretic treatment, history of heart failure, albuminuria or ongoing infections were excluded. The population was divided into tertiles according to their ACR values, Tercile 1: patients with ACR values from 0 to 4 mg/g, Tercile 2: from 4 to 17 mg/g and a Tercile 3: higher than 17 mg/g. The end point of the analysis was long-term follow-up mortality. Univariate and multivariate Cox logistic regression analysis was performed to identify variables independently associated with mortality at follow-up in diabetic and non-diabetic patients. Statistics were calculated using IBM Statistics SPSS version 26. Results Median follow-up was 12 years (95% CI 11-14). 106 of the 600 patients with NSTEACS were diabetic (17.7%). Figuer 1 shows the baseline characteristics between diabetic and non-diabetic patients. Figure 1 shows the actuarial survival curves (Kaplan Meier) according to the three tertiles of CAI in diabetic patients (A) log rank test (chi-square) of 31.14 p < 0.0001 and in non-diabetic patients (B) log rank test (chi-square) 121.62, p < 0.0001. Figure 2 A shows the univariate and multivariate Cox analysis in diabetic NSTEACS patients and in Figure 2B the same analysis in non-diabetics, where it is observed that the CAI is an independent predictor of mortality in both populations: Adjusted OR for distant mortality was 10.12 (9.91-13.34) p = 0.005 in diabetic patients and 11.65 (3.3-5.4) p = 0.01 in non-diabetic patients. Conclusion ACR is an independent predictor of long-term all-cause mortality in patients with NSTEACS, both in diabetic and non-diabetic patients.
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Higa et al. (2025) conducted a cohort in non-ST-segment elevation acute coronary syndrome (NSTEACS) (n=600). Albumin-to-creatinine ratio (ACR) vs. Lower ACR tertiles was evaluated on long-term all-cause mortality (OR 10.12, 95% CI 9.91-13.34, p=0.005). Albumin-to-creatinine ratio independently predicted long-term mortality in NSTEACS, with an adjusted OR of 10.12 (95% CI 9.91-13.34) in diabetics and 11.65 (95% CI 3.3-5.4) in non-diabetics.
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