The Change Of Urinary Albumin-to-creatinine Ratio In Patients With Coronary Heart Disease And The Relationship Between Urinary Albumin-to-creatinine Ratio And The Severity Of Coronary Stenosis

Objective:To investigate wether there is a certain relationship between Urinary albumin-to-creatinine ratio (UACR) and coronary heart disease and investigate the relationship between UACR and acute coronary syndrome(ACS).Method:The current study was designed as an observational prospective study. The study group consisted of 834 patients who took examination and therapy in Zhongshan hospital from July,2009 to January,2010. Patients with other serious heart disease such as dilated cardiomyopathy were excluded from the study. Patients were divided into 2 groups based on the presence of coronary artery disease(CAD).We also divided the groups based on the presence of diabetes mellitus(DM),and compared the difference between groups,particularly the level of the UACR.Then we divided the 497 patients with CAD into 2 groups based on the presence of ACS. We also divided the groups based on the presence of DM,and compared the difference between them.ROC curve was used to find out the meaningful level of UACR.A multivariate logistic regression analysis was performed to evaluate the effects of the variables on CAD and ACS.Results:The LnUACR was 1.82±0.95 vs 2.01±1.15 (P<0.05) in the CAD group and non-CAD group.The ROC curve is smooth, with no clear demarcation point. Multivariate logistic regression analysis shows UACR is not independent risk factor of CAD, gender,age,smoking and hypertension are independent risk factors of CAD. The LnUACR was 2.25±1.18 vs 1.83±1.09(P<0.001) in the ACS group and non-ACS group.But no matter in the DM(+) or DM(-) group,there is not a significant difference between CAD patients and non-CAD patients.And no matter in the DM(+) or DM(-) group,there is a significant difference between CAD patients and non-CAD patients(P<0.01 and P<0.001). The ROC curve shows the meaningful demarcation point is 7.2mg/g of UACR. Multivariate logistic regression analysis shows UACR(OR=1.263;95%CI,1.056-1.511;P<0.05)and CRP (OR=1.262;95%CI,1.078- 1.477;P<0.01) are independent risk factors of ACS.Conclusion:The multivariate logistic regression analysis shows UACR is not an independent risk factor of CAD,but an independent risk factor of ACS. The presence of DM has a significant influence on the rise of UACR.It might be a strong predict effect between UACR and ACS,even far below the known level of 30mg/g.Objective:To investigate the relationship between Urinary albumin-to-creatinine ratio and the severity of coronary stenosis in patients with coronary heart disease.Method:The current study was designed as an observational prospective study. The study group consisted of 303 CAD patients who underwent coronary angiography in Zhongshan hospital from July,2009 to January,2010. Patients with other serious heart disease such as dilated cardiomyopathy and the patients who has already underwent PCI or CABG before were excluded from the study. Patients were divided into 4 groups based on the presence of diabetes mellitus(DM) and MA:DM(+)/MA(+), DM(+)/MA(-),DM(-)/MA(+),and DM(-)/MA(-).We compared the difference between groups,including the proportion of 2or3-vessel CAD,Gensini score and other clinical characters.A Spearman correlation analysis was performed to evaluate the relationship between UACR and the Gensini score.A multivariate linear regression analysis was also performed to evaluate the effects of the variables on the severity of CAD.Results:The Gensini score was 75.0±46.7 vs 38.8±24.8 (P0.01) in the DM(+)/MA(+) and DM(+)/MA(-) groups;and 51.8±43.23 vs 24.0±21.4(P<0.01) in the DM(-)/MA(+) and DM(-)/MA(-) groups.And the proportion of 2or3-vessel CAD was much higher in DM(-)/MA(+) group than in DM(-)/MA(-) group(P<0.01).Spearman correlation analysis demonstrated a positive relation between UACR and extent of CAD both in the diabetic and nondiabetic patients (r=0.349,P<0.01;r=0.254;P<001). A multivariate linear regression analysis showed microalbuminuria was an independent predictor for the severity of CAD (P<0.001,β=0.370).Conclusion:There is a strong relationship between MAU and the severity of CAD both in patients with diabetes mellitus and without diabetes mellitus,and it has an independent influence on severity of coronary stenosis.