Pre-procedural urine albumin-to-creatinine ratio and one-year major adverse cardiovascular events following percutaneous coronary intervention

Background/Introduction

Urine albumin-to-creatinine ratio (uACR) is an established marker of early kidney dysfunction and a predictor of chronic kidney disease progression. Beyond renal risk, albuminuria reflects systemic endothelial dysfunction and has been associated with adverse cardiovascular outcomes.

Purpose

To evaluate whether pre-procedural uACR predicts 1-year major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI).

Methods

We conducted a retrospective analysis of patients undergoing PCI at a single tertiary center between 2012 and 2023. Individuals with available uACR measurements within 1 year prior to PCI were included. Patients were stratified into three groups: uACR <30 mg/g, 30–<300 mg/g, and ≥300 mg/g. The primary endpoint was 1-year MACE, defined as the composite of all-cause mortality and myocardial infarction (MI). Hazard ratios (HR) were calculated using Cox proportional hazards models. Secondary endpoint was acute kidney injury (AKI) within 48 hours post-PCI as defined by either >0.3mg/dL increase or >50% increase in serum creatinine from baseline.

Results

Among 1,220 patients, 728 (59.7%) had uACR <30 mg/g, 375 (30.7%) had uACR 30–<300 mg/g, and 117 (9.6%) had uACR ≥300 mg/g. Higher uACR was associated with a greater burden of comorbidities, including chronic kidney disease (35.7% vs. 65.0%) and diabetes mellitus (78.6% vs. 86.3%) across increasing uACR categories (Table 1).

At 1 year, there was a stepwise increase in MACE across uACR groups. Compared with the reference group (uACR <30 mg/g), patients with uACR 30–<300 mg/g had a non-significant increase in risk (HR 1.22, 95% CI 0.87–1.72; p=0.25), whereas those with uACR ≥300 mg/g had a significantly higher risk of MACE (HR 1.66, 95% CI 1.04–2.65; p=0.03). A significant trend was observed across categories (p-trend=0.03) (Figure 1).

Severe albuminuria was associated with higher rates of peri-procedural AKI, occurring in 14.3% of patients with uACR ≥300 mg/g compared with 7.2% and 6.2% in the lower uACR groups (p=0.011 and p=0.007 for comparisons vs ≥300 mg/g).

Conclusion

Elevated pre-procedural uACR is associated with a stepwise increase in 1-year MACE following PCI. Severe albuminuria (≥300 mg/g) identifies a high-risk population with significantly worse ischemic outcomes. These findings suggest that uACR may provide incremental risk stratification prior to PCI.Figure 1Table 1