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Dipstick proteinuria as a surrogate marker of long-term mortality after acute myocardial infarction
Hisanobu Ota1, Toshiharu Takeuchi, Nobuyuki Sato
1Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
Insights
Proteinuria, not reduced estimated glomerular filtration rate (eGFR), is a significant predictor of long-term mortality after acute myocardial infarction (AMI). Early detection of proteinuria can identify high-risk patients for improved outcomes.
Area of Science:
- Cardiology
- Nephrology
- Clinical Research
Background:
- Proteinuria and reduced estimated glomerular filtration rate (eGFR) are linked to increased mortality risk following acute myocardial infarction (AMI).
- The comparative prognostic value of proteinuria versus eGFR for all-cause mortality post-AMI remains unclear.
Purpose of the Study:
- To compare the prognostic value of proteinuria and eGFR for predicting all-cause mortality in patients after AMI.
- To investigate the association of proteinuria and eGFR with brain natriuretic peptide (BNP) levels and long-term mortality.
Main Methods:
- 101 patients admitted with AMI undergoing angioplasty were assessed for dipstick proteinuria and eGFR on admission.
- Patients were grouped based on the presence/absence of proteinuria and eGFR levels (<60 vs. >60 mL/min/1.73m²).
- 3-year all-cause mortality was evaluated using Kaplan-Meier analysis and a multivariate Cox proportional hazards model.
Main Results:
- Higher BNP levels were observed in patients with proteinuria and lower eGFR.
- Both proteinuria and lower eGFR were associated with significantly higher 3-year all-cause mortality.
- Proteinuria, but not lower eGFR, was identified as an independent predictor of all-cause mortality in the Cox model.
Conclusions:
- Dipstick proteinuria and reduced eGFR in early AMI follow-up correlate with elevated BNP and adverse long-term outcomes.
- Dipstick proteinuria emerges as a potentially valuable prognostic marker for long-term all-cause mortality after AMI.
Background:
Proteinuria and reduced estimated glomerular filtration rate (eGFR) are associated with an increased risk of mortality from acute myocardial infarction (AMI). However, it is unknown whether there is a difference in prognostic value for all-cause mortality between proteinuria and eGFR during post-AMI.
Methods:
A consecutive series of 101 patients admitted with AMI who received angioplasty were enrolled. Dipstick proteinuria and eGFR were assessed on admission: (i) the patients were divided into 2 groups according to the presence of proteinuria (proteinuria, n=25), or not (negative, n=76), (ii) the patients were divided into 2 groups according to lower eGFR (GFR<60mL/min/1.73m(2), n=31) or higher (GFR>60mL/min/1.73m(2), n=70). Clinical characteristics and 3-year all-cause mortality estimated by Kaplan-Meier method were evaluated in each group. Additionally, a multivariate Cox proportional hazards model was applied to evaluate which factor was associated with all-cause mortality.
Results:
Mean follow-up period was 914 days. Higher brain natriuretic peptide (BNP) levels were shown in the proteinuria and lower eGFR groups, respectively (proteinuria, 301±324pg/mL; negative, 146±159pg/mL; p=0.02; lower eGFR, 294±305pg/mL; higher eGFR, 142±161pg/mL; p=0.02). Three-year all-cause mortality was higher in the proteinuria group than in the normal group (p<0.001) and in the lower eGFR group than in the higher group (p=0.006). In a Cox proportional hazards model, the presence of proteinuria [hazard ratio (95% confidence interval), 4.51 (1.07-18.96); p=0.04] was selected as one of the predictors for all-cause mortality.
Conclusions:
Dipstick proteinuria and lower eGFR in the early phase of AMI follow-up were related to increased plasma BNP level during the sub-acute phase and long-term adverse outcome. Dipstick proteinuria may be a prognostic marker for long-term all-cause mortality.
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