Significant association between elevated urine albumin-to-creatinine ratio and increased risk of acute coronary syndrome: a retrospective cross-sectional analysis

Acute coronary syndrome (ACS) is a major cause of mortality worldwide. Chronic kidney disease (CKD) is associated with cardiovascular disease. However, whether CKD increases the risk of ACS, indicating its effect on plaque rupture or erosion, needs to be elucidated. This cross-sectional study analyzed the data from patients with coronary artery disease who underwent percutaneous coronary intervention (PCI) between 2016 and 2020. Patients were categorized according to urinary albumin-to-creatinine ratio (UACR) elevation, estimated glomerular filtration rate (eGFR), or Kidney Disease: Improving Global Outcomes (KDIGO) risk classification. Setting chronic coronary syndrome (CCS) as the control, logistic regression was used to evaluate the associations between elevated UACR, eGFR, KDIGO stage, and ACS. Confounding for adjustment included age, sex, hypertension, diabetes, LDL, triglycerides, heart failure, and coronary artery disease-reporting and data system (CADRADS) score. This cross-sectional study included 1,137 patients with available UACR data (62.9%) from a total of 1806 coronary artery disease (CAD) subjects. Microalbuminuria and macroalbuminuria were associated with an increased risk of ACS (OR = 1.63, 95% CI: 1.15–2.32, <i>p</i> = 0.007 and OR = 2.07, 95% CI: 1.18–3.62, <i>p</i> = 0.011). Decreased eGFR, elevated UACR, and higher KDIGO stage were correlated with the severity of coronary artery stenosis, and patients with a UACR≥ 300 mg/g had the most severe stenosis (OR, 1.74; 95% CI: 1.07–2.83, <i>p</i> = 0.026). Elevated UACR remained correlated with ACS, even after adjusting for the CADRADs score. Elevated UACR is significantly associated with ACS, suggesting a potential mechanistic role of UACR elevation in plaque rupture or erosion. Early UACR monitoring in CCS is important for preventing ACS.