Relationship between Hyponatremia and In-hospital Outcomes in Chinese Patients with ST-Elevation Myocardial Infarction

Abstract

Objective This study was investigated to determine the relationship between hyponatremia and in-hospital outcomes in Chinese patients with ST-elevation myocardial infarction. Methods Plasma sodium concentration was obtained in all patients on admission and analyzed as hyponatremia versus normalnatremia. The relationships between hyponatremia and in-hospital mortality as well as heart failure were assessed. Results Of 1,620 patients, 212 (13.1%) patients had hyponatremia on presentation (sodium <135 mmol/L). Patients with hyponatremia had higher rates of in-hospital mortality (13.7% vs. 7.3%, p=0.002) and heart failure (30.2% vs. 18%, p<0.001). Patients with a sodium level of <130 mmol/L had an adverse event rate of 22.9% versus 11.0% in patients with a sodium level of 130 to 135 mmol/L (p=0.034). In multivariate logistic regression, hyponatremia was independently correlated with in-hospital mortality (OR: 1.77, 95% CI: 1.02-3.06, p=0.042) and heart failure (OR: 1.61, 95% CI: 1.06-2.43, p=0.025). Conclusion Hyponatremia is independently associated with in-hospital adverse outcomes in Chinese patients with acute ST-elevation myocardial infarction, and the risk of in-hospital mortality was increased with the severity of hyponatremia.

Short- and long-term prognostic value of hyponatremia in patients with acute coronary syndrome: A systematic review and meta-analysis

“…12 studies [ 13 , 15 – 18 , 20 , 22 – 26 , 32 ] were included in the meta-analysis for the association of hyponatremia in acute coronary syndrome patients with the risk of short-term mortality, which included in-hospital mortality and all-cause mortality within 30 days. The relative risks for this association varied from 1.26 to 5.80 among 12 studies.…”

“…Subgroup analyses were conducted according to the serum Na + levels(130-134mmol/L and <130mmol/L).Of 20 studies, 4 studies[ 13 , 16 , 22 , 26 ] reported effect estimates on the serum sodium levels with short-term mortality, the analyses of subgroups were provided in Fig 4 . The pooled RRs in relation to 130-134mmol/L were 1.78 (95%CI: 1.34–2.35; P<0.001).The incidence of short-term mortality was significantly increased by 364% (RR: 3.64; 95%CI: 2.46–5.40; P<0.001) in patients with the serum sodium levels<130 mmol/L.…”

In-hospital Outcome of Acute Coronary Syndrome Patients with on-Admission Hyponatremia

“…(p=0.011). Qing Tang et al 17 showed the LV ejection fraction was 51.65±9.05% vs. 54.83±8.95% between two groups of Chinese patients with STEMI. Goldberg et al 11 showed 47±13% vs. 42±13% between two groups STEMI patients.…”

“…5,6,16 According to a past study, the plasma AVP level was significantly higher in patients who had a fatal outcome after AMI. 17 The prevalence and importance of hyponatremia in patients with acute coronary syndrome in the era of primary intervention, however, have not yet been fully established.…”

“…The frequency of hyponatremia in our study is higher than the prevalence observed by Qing Tang et al in a study with Chinese population with STEMI and which was 13.1%. 17 This difference between two studies may be due to inclusion of NSTEMI and UA and difference in size and food habit. Lazzeriet al observed 23.2% incidence of hyponatremia in acute STEMI patients.…”