Document Detail


Aldosterone and long-term outcome after myocardial infarction: A substudy of the french nationwide Observatoire sur la Prise en charge hospitalière, l'Evolution à un an et les caRactéristiques de patients présentant un infArctus du myocarde avec ou sans onde Q (OPERA) study.
MedLine Citation:
PMID:  19332195     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: High plasma aldosterone levels at presentation are correlated to poor outcome after ST elevation acute myocardial infarction (AMI). Whether there is a relationship between aldosterone levels and outcome in a broader spectrum of patients admitted for AMI defined by the new definition based on troponin levels remains unknown. METHODS: Plasma aldosterone, C-reactive protein, and brain natriuretic peptide (BNP) were measured in 471 patients, 24 and 72 hours after admission for AMI defined by the new definition. The primary outcome was the composite of death, resuscitated cardiac arrest, recurrent/extended myocardial infarction, recurrent ischemia, heart failure, and stroke. RESULTS: The highest aldosterone levels quartile at 24 hours was significantly associated with the occurrence of the primary outcome (P < .0001), death (P < .05), heart failure (P < .05), ventricular (P < .0001) and supraventricular arrhythmias (P < .05), and acute renal failure (P < .01) during the in-hospital period, and higher rates of mortality (P < .05) at 1-year follow-up. Independent correlates of the primary outcome at 1 year were age > or =73 (odds ratio [OR] 2.22 [1.38-3.57]), heart failure (OR 6.46 [1.99-20.98]), 24-hour aldosterone > or =103.6 pg.mL(-1) (OR 1.72 [1.07-2.77]), and BNP > or =389 pg.mL(-1) (OR 2.35 [1.44-3.84]) concentrations. The model applied to the 72-hour variables, identified the same correlates. CONCLUSIONS: Using the new definition of AMI, based on troponin levels, regardless of ST-segment elevation and management strategies, high aldosterone concentration is associated with major adverse in-hospital events and is an independent correlate of clinical outcome at 1 year. These findings warrant trials assessing the benefit of early aldosterone blockade in such patients.
Authors:
Farzin Beygui; Gilles Montalescot; Eric Vicaut; Stephanie Rouanet; Eric Van Belle; Cathrine Baulac; Alexia Degrandsart; Jean Dallongeville;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study     Date:  2009-03-17
Journal Detail:
Title:  American heart journal     Volume:  157     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-31     Completed Date:  2009-04-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  680-7     Citation Subset:  AIM; IM    
Affiliation:
Institut de Cardiologie and INSERM U, Pitié-Salpétrière University Hospital, APHP, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Aldosterone / blood*
Female
Follow-Up Studies
France / epidemiology
Humans
Male
Middle Aged
Myocardial Infarction / blood*,  mortality
Prognosis
Prospective Studies
Registries*
Risk Factors
Survival Rate / trends
Chemical
Reg. No./Substance:
52-39-1/Aldosterone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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