Plasma aldosterone levels during hospitalization are predictive of survival post-myocardial infarction.

Abstract

Plasma aldosterone levels have been shown to be associated with adverse clinical outcomes after ST-elevation myocardial infarction (STEMI). We investigated whether aldosterone levels in patients presenting with STEMI or non-STEMI, are predictive of mortality during prolonged follow-up. Aldosterone levels were assayed in plasma taken from 583 patients within 24-96 h following acute myocardial infarction (MI). The median plasma aldosterone level was 108 pmol/L and all values were below the upper limit of the normal range (800 pmol/L) except for five patients (0.9%). Aldosterone tertile was significantly associated with increasing plasma levels of NTproBNP (N-terminal pro-B-type natriuretic peptide), BNP (B-type natriuretic peptide), epinephrine, and endothelin-1 (P <or= 0.010), but not ANP (atrial natriuretic peptide). Patients in the lowest aldosterone tertile had a significantly better survival, over 5 years' follow-up, than those in the upper two tertiles (P = 0.0023). Multivariable analysis showed that aldosterone was a significant predictor of survival following adjustment for established predictors (tertile 1 vs. tertile 3; hazard ratio = 2.19, P = 0.018). Patients with above-median levels of both NTproBNP and aldosterone had significantly greater mortality than the remaining patients (above-median 39.8%, other patients >or=25.3% mortality, P >or= 0.026). Plasma aldosterone levels post-MI are independent predictors of survival and hospitalization for heart failure over a 5-year-follow-up period.