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 m(2).
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.