Hypertension, albuminuria and fatal stroke long after acute coronary syndrome – the ABC study on acute coronary syndrome
4th International Conference on Hypertension & Healthcare
September 10-11, 2018 | Zurich, Switzerland
Giuseppe Berton1, Rocco Cordiano2, Fiorella Cavuto3, Heba T Mahmoud4, Mattia asquinucci4 and Beatrice Segafedo4
Conegliano General Hospital, Conegliano, Italy2
Adria General Hospital, Adria, Italy3
Bassano del Grappa General Hospital, Bassano del Grappa, Italy4
ABC Study on Heart Disease Association, Italy
Statement of the Problem:
Systolic blood pressure (SBP) is a well-known important predictor of stroke risk. Likewise, there is a significant and independent association between microalbuminuria and subsequent stroke risk.
The purpose of this study is to assess the combined effect of hypertension and microalbuminuria on the risk of fatal stroke in patients with acute coronary syndrome (ACS) through 17 years of follow–up.
Methodology & Theoretical Orientation:
The present study includes 589 patients with AMI enrolled in three intensive coronary
care units and discharged alive. Baseline, clinical and laboratory data were recruited within the first 7 days of hospitalization. We used a competitive risk regression models to assess the risk of developing fatal stroke. Analyses were made using STATA 14.
After discharge, 33 (5.6%) of the patients developed fatal stroke (FS), comparing them to the patients who didn’t; there was no significant difference in the clinical characteristics except that they were significantly older (mean age was 72.5±7.8 vs. 65.3±11.9 years, p=0.0007) and more frequently hypertensive patients (67% vs. 46% p=0.02). In patients with FS, 3rd day
albumin-creatinine ratio (ACR) values were significantly higher (p=0.001) and microalbuminuria was more prevalent 55% vs. 32%, (p=0.004). At univariable competitive risks regression; hypertensive patients had higher risk of develop FS, hazard ratio (HR)=2.3 (95% CI=1.1–4.7) p=0.02. Similar HRs were observed after an adjusted model for age gender and hospital site was set HR=2.1 (95% CI=1.0–4.4) p=0.04. In the adjusted model, patients with both hypertension and microalbuminuria showed an independent risk association for developing FS than patients with neither, HR=3.6 (95% CI=1.3–10.3) p=0.01.
Conclusion & Significance:
This study, show that the combination of hypertension and microalbuminuria is associated with a greater risk of development of fatal stroke long after ACS, independently of the degree of heart failure and other confounders.