Proteinuria was associated with cardiovascular events and mortality in community-based
cohorts. The association of proteinuria with mortality and cardiovascular events in
patients undergoing percutaneous coronary intervention (PCI) was unknown. The association
of urinary dipstick proteinuria with mortality and cardiovascular events (composite
of death, myocardial infarction, or nonhemorrhagic stroke) in 5,835 subjects of the
EXCITE trial was evaluated. Dipstick urinalysis was performed before PCI, and proteinuria
was defined as trace or greater. Subjects were followed up for 210 days/7 months after
enrollment for the occurrence of events. Multivariate Cox regression analysis evaluated
the independent association of proteinuria with each outcome. Mean age was 59 years,
21% were women, 18% had diabetes mellitus, and mean estimated glomerular filtration
rate was 90 ml/min/1.73 m2. Proteinuria was present in 750 patients (13%). During follow-up, 22 subjects (2.9%)
with proteinuria and 54 subjects (1.1%) without proteinuria died (adjusted hazard
ratio 2.83, 95% confidence interval [CI] 1.65 to 4.84, p <0.001). The severity of
proteinuria attenuated the strength of the association with mortality after PCI (low-grade
proteinuria, hazard ratio 2.67, 95% CI 1.50 to 4.75; high-grade proteinuria, hazard
ratio 3.76, 95% CI 1.24 to 11.37). No significant association was present for cardiovascular
events during the relatively short follow-up, but high-grade proteinuria tended toward
increased risk of cardiovascular events (hazard ratio 1.45, 95% CI 0.81 to 2.61).In
conclusion, proteinuria was strongly and independently associated with mortality in
patients undergoing PCI. These data suggest that such a relatively simple and clinically
easy to use tool as urinary dipstick may be useful to identify and treat patients
at high risk of mortality at the time of PCI.
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Article info
Publication history
Published online: August 11, 2008
Accepted:
June 11,
2008
Received in revised form:
June 11,
2008
Received:
April 15,
2008
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
