High Plasma Aldosterone Levels on Admission Are Associated With Death in Patients Presenting With Acute ST-Elevation Myocardial Infarction

Abstract

Background-Aldosterone, the final mediator of the renin-angiotensin-aldosterone pathway, is at its highest plasma levels at presentation for ST-elevation myocardial infarction (STEMI). Whether aldosterone level at presentation for STEMI is associated with adverse outcome remains unknown. Methods and Results-Plasma aldosterone levels were measured at presentation in consecutive patients referred for primary percutaneous coronary intervention for STEMI. We assessed the association between aldosterone levels and in-hospital events and mortality during a 6-month follow-up. Of 356 STEMI patients, 23 and 36 died during the hospital stay and 6-month follow-up period, respectively. Nine other patients survived in-hospital cardiac arrest. High aldosterone levels were associated with an almost stepwise increase in rates of in-hospital death (Pϭ0.01), cardiovascular death (Pϭ0.03), heart failure (Pϭ0.005), ventricular fibrillation (Pϭ0.02), and resuscitated cardiac arrest (Pϭ0.01). After adjustment for age, Killip class, and reperfusion status, compared with patients in the first aldosterone quartile group, those in the highest quartile were at higher risk of death (hazard ratio 3.28, 95% CI 1.09 to 9.89, Pϭ0.035) and death or resuscitated cardiac arrest (hazard ratio 3.74, 95% CI 1.40 to 9.98, Pϭ0.008) during the follow-up. Conclusions-Plasma aldosterone levels on admission among patients referred for primary percutaneous coronary intervention for STEMI are associated with early and late adverse clinical outcomes, including mortality. The association between high aldosterone levels and late mortality is independent of age, heart failure, and reperfusion status. Such results underline the pivotal role of aldosterone and justify a randomized trial to assess the early administration of aldosterone antagonists in the setting of STEMI.

Glucocorticoids Activate Cardiac Mineralocorticoid Receptors During Experimental Myocardial Infarction

“…25 These studies testify to the direct cardiotoxic effects of elevated aldosterone levels over and above those of elevated blood pressure, per se. In the setting of ST-elevation myocardial infarction, a strong association between plasma aldosterone levels (even within the normal range) and risk of both early and late mortality has been shown in heart failure, 26 in further support of direct cardiotoxic effects.…”

Preconditioning actions of aldosterone through p38 signaling modulation in isolated rat hearts

“…However, the pathophysiological significance of the increase (even by a small amount) in aldosterone levels both in circulation and local tissue, as well as its cascade activation in severe heart diseases (Mizuno et al 2001, Nakamura et al 2004, such as myocardial infarction (Beygui et al 2006), has not yet been fully clarified.…”

Aldosterone Levels and Heart Remodeling in Myocardial Infarction Patients With Non-Differentiated Connective Tissue Dysplasia

“…В настоящее время обсуждается патогенетическая роль альдостерона в развитии инфаркта миокарда (ИМ) и постинфарктного ремоделирования сердца [6][7][8][9]. Одной из основных точек приложения дей-ствия альдостерона в данном случае является миокар-диальная соединительная ткань, состояние которой играет важную роль в течении репаративно-восстано-вительных процессов, протекающих в сердечной мышце после развития ИМ.…”