STOCKHOLM — Patients with proteinuria following a myocardial infarction had significantly worse outcomes than did patients without proteinuria, Powell O. Jose reported in a poster presentation at the annual meeting of the European Society of Cardiology.
“Assessing proteinuria in patients following an MI may improve their risk stratification,” said Mr. Jose, a researcher at Brigham and Women's Hospital in Boston.
The analysis used data collected in the Survival and Ventricular Enlargement (SAVE) trial, one of the first studies to establish the efficacy of an ACE inhibitor in patients with left ventricular dysfunction after an MI (N. Engl. J. Med. 1992;327:669-77).
The post hoc analysis by Mr. Jose and his associates focused on 583 of the 2,231 patients in the SAVE trial who were assessed for proteinuria with a dipstick test when they entered the study. The urine tests showed that 122 patients had proteinuria and 461 did not. During an average follow-up of 42 months, patients with proteinuria had a 31% total mortality and a 27% incidence of cardiovascular mortality, compared with a 20% total mortality and a 17% cardiovascular mortality in the patients without proteinuria.
In a multivariate analysis that controlled for demographic and clinical measures, patients with proteinuria were 73% more likely to die from any cause and 81% more likely to die from cardiovascular disease, compared with MI patients without proteinuria. Both of these differences were statistically significant.
The link between proteinuria and mortality was most dramatic in the 35 patients who had significant proteinuria. In this subgroup, the all-cause mortality during follow-up was 46%, whereas in the 87 patients with trace proteinuria, the all-cause death rate was 25%. In patients without proteinuria, mortality during follow-up was 20%.
