الفهرس 
Microalbuminuria in patients with DMOnly 14 pages are availabe for public view
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Abstract
This prospective study was conducted in order to find out the association between urinary albumin creatinine ratio and severity/extent of coronary artery disease as revealed by coronary angiography in patients with type II DM undergoing elective coronary procedures. Sixty patients were included in the study. Their mean age was 55.2 ± 9.4 years, 37 were males (61.6%). Patients with acute coronary syndrome, congestive heart failure, chronic renal disease or urinary albumin creatinine ratio more than 300 mg/g, hepatic failure and urinary system pathology were excluded from the study.
All patients underwent assessment of urinary albumin creatinine ratio, urinary albumin excretion, serum creatinine and blood urea nitrogen. Patients underwent elective coronary angiography.
Thirty seven patients (61.7%) had significant coronary artery disease and 23 patients (38.3%) had normal or insignificant coronary artery disease. The patients with significant coronary artery disease (group II) had significantly more frequent positive family history of ischemic heart disease, prior myocardial infarction and prior percutaneous coronary intervention (P < 0.05 for all).
The mean urinary albumin excretion and urinary albumin creatinine ratio were significantly higher in group II patients compared with group I (29.7±20.5 versus 11.7±11.6 and 96.8±76.8 versus 25.4±15.4 respectively) (P < 0.05 for both).
There were 12 (20%) patients with multi-vessel disease. There were 8 (13%) patients with 2 vessel disease. There were 17 (28%) patients with single-vessel disease. There were 23 (38.3%) patients with normal coronaries or insignificant coronary artery disease. The mean Gensini score were significantly higher among group II patient versus group I (33.2±24.4 versus 0.6±1.3) (p< 0.001).
The univariate regression analysis identified the following as predictors of multi-vessel disease: urinary albumin excretion, urinary albumin creatinine ratio and blood urea nitrogen (p<0.05 for all).
The multivariate regression analysis identified no independent predictors of multi-vessel disease among all predictors.
Pearson’s correlation test showed that the Gensini score was strongly correlated with UACR (r = 0.78, p = <0.001), UAE (r = 0.65, p = <0.001), and Blood urea nitrogen (r = 0.45, p = <0.001); and positively correlated with serum creatinine (r = 0.31, p = 0.014).
The patients with affection of 3 or more vessel had significantly higher urinary albumin excretion, urinary albumin creatinine ratio and blood urea nitrogen, compared with those with less extensive coronary artery disease (p<0.05 for all).
ROC curve analysis demonstrated that the optimal cutoff value of urinary albumin creatinine ratio that best predicts MVD was > 85mg/gram. Using this cutoff value, UACR predicts MVD with sensitivity 83.3%, specificity 84%, positive predictive value 71.4%, negative predictive value 91.3%, and accuracy 86.7%.
ROC curve analysis showed that the optimal cutoff value of urinary albumin excretion that best predicts MVD was > 30 mg/dl. Using this cutoff value, UAC predicts MVD with sensitivity 83%, specificity 80%, positive predictive value 66.7%, negative predictive value 90.9%, and accuracy 83.2%.
ROC curve analysis showed that the optimal cutoff value of serum creatinine that best predicts MVD was > 0.8mg/dl. Using this cutoff value, serum creatinine predicts MVD with sensitivity 91.7%, specificity 32%, positive predictive value 39.3%, negative predictive value 88.9% and accuracy 62.5%.
ROC curve analysis showed that the optimal cutoff value of blood urea nitrogen that best predicts MVD was > 16 mg/dl. Using this cutoff value, blood urea nitrogen predicts MVD with sensitivity 83.3%, specificity 68%, positive predictive value 55.6 %, negative predictive value 89.5% and accuracy 77%.