Albuminuria predicts mid-term mortality of elective drug eluting stent implantation in patients with type 2 diabetes mellitus

YANG Jun-qing; RAN Peng; SUN Shuo; HE Xu-yu; NI Zhong-han; GUO Xiao-sheng; CAI An-ping; TU-ER-XUN-JIANG A-bu-du-ai-ni; LUO De-mou; LIU Yong; LI Li-wen; ZHOU Ying-ling; CHEN Ji-yan

摘要：Background The influence of alburninuria on clinical outcomes in patients with type 2 diabetes mellitus (T2DM) after elective percutaneous coronary intervention(PCI) with drug-eluting stent (DES) implantation remains unclear.Methods We observed 386 patients with T2DM after elective PCI.The patients were stratified based on the early morning urinary albumin:negative (n =309),trace (urine dipstick trace,n =39),and positive group (urine dipstick ≥1 +,n =38).Kaplan-Meier curve analysis was used to compare the cumulative rates of clinical outcomes (all-cause death,cardiovascular death,MACEs:cardiovascular death,non-fatal myocardial infarction,stroke or revascularization).Cox regression was performed to assess the risk factors for all-cause death and cardiovascular death.Results Median follow-up was 25 months (IQR:17-37 months).Twenty eight (7.3％,13 in the negative group,3 in the trace group and 12 in the positive group) patients died during the entire study period,2 of them (0.7％,1 in the negative group and 1 in the trace group)died during index hospitalization.Positive albuminuria group suffered more contrast-induced acute kidney injury (CI-AKI) and dialysis during hospitalization.The cumulative all-cause death (34.5％ vs.8.9％ vs.4.9％,P Negative vs.Trace =0.333,P Negative vs.Positive ＜ 0.001,P Trace vs.Positive =0.013,log-rank P ＜ 0.001) and cardiovascular death (29.5％ vs.7.4％ vs.3.4％,P Negative vs.Trace =0.458,PNegative vs.Positive ＜ 0.001,P Trace vs.Positive =0.014,log-rank P ＜ 0.001) were highest in the positive group.MACE also tends to increase in positive group.After adjusting for potential confounding risk factors,positive albuminuria was still related to all-cause death (HR =5.13,95％ CI:2.21-11.89,P ＜ 0.001) and cardiovascular death (HR =5.40,95％ CI:2.07-14.09,P =0.001).Conclusion Preprocedural albuminuria predicts poor clinical outcomes,including all-cause death and cardiovascular death,in T2DM patients after elective PCI with DES implantation.