Hyponatraemia on admission to hospital is associated with increased long-term risk of mortality in survivors of myocardial infarction
Hyponatraemia on admission to hospital is associated with increased long-term risk of mortality in survivors of myocardial infarction
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DOI：
10.1177/2047487314557963
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发表时间：
2015-11-01
影响因子：
8.3
通讯作者：
Meisinger, Christa
中科院分区：
文献类型：
--
作者：
Burkhardt, Katrin;Kirchberger, Inge;Meisinger, Christa
低钠血症与心力衰竭和急性ST段抬高型心肌梗死（STEMI）患者死亡风险增加相关。目的是评估低钠血症对首次STEMI或非STEMI（NSTEMI）患者长期死亡率的影响。设计这是一项纵向观察研究方法研究人群包括3558例患者，年龄25-74岁，在2000-2008年发生急性心肌梗死（AMI），存活至少28天。所有连续患者均通过奥格斯堡地区合作健康研究（KORA）心肌梗死登记处登记。入院时获得血清钠水平。与长期死亡率的关联进行了检查，使用考克斯回归models.Results低钠血症，定义为钠水平低于136 mmol/L，是目前在658（18.5%）患者入院。在6年的中位随访期间（四分位距（IQR）4.0-8.2年），526例患者（14.8%）死亡。低钠血症与长期死亡率显著相关，在年龄和性别校正分析中，低钠血症的风险增加83%。在进一步校正左心室射血分数（LVEF）降低、肾小球滤过率、血红蛋白、高血压、高钠血症、任何再通治疗、糖尿病、入院前使用利尿剂和血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂的药物和其他参数后，低钠血症仍然是长期死亡率较高的强预测因素结论急性心肌梗死合并低钠血症患者的远期死亡率明显高于无低钠血症患者。这一强预测值与许多预后因素无关，包括糖尿病、肾小球滤过率或LVEF降低。
Background Hyponatremia is associated with an increased risk of mortality in patients with heart failure and in acute ST-segment elevation myocardial infarction (STEMI). The aim was to assess the impact of hyponatremia on admission on long-term mortality of patients with first ever STEMI or non-STEMI (NSTEMI).Design This was a longitudinal observation studyMethods The study population consisted of 3558 patients, aged 25-74 years, with an incident acute myocardial infarction (AMI) in the years 2000-2008 who survived for at least 28 days. All consecutive patients were registered through the Cooperative Health Research in the Region of Augsburg (KORA) Myocardial Infarction Registry. Serum sodium levels were obtained on admission. The association with long-term-mortality was examined using Cox regression models.Results Hyponatraemia, defined as a sodium level less than 136mmol/l, was present in 658 (18.5%) patients on admission. During a median follow-up period of six years (interquartile range (IQR) 4.0-8.2 years), 526 patients (14.8%) died. Hyponatraemia was significantly associated with long-term mortality by an 83% higher risk in the age- and sex-adjusted analysis. After further adjustment for reduced left ventricular ejection fraction (LVEF), glomerular filtration rate, haemoglobin, hypertension, hyperlipidaemia, any recanalization therapy, diabetes, medication with diuretics and angiotensin-converting enzyme (ACE) inhibitor/angiotensin-receptor blocker before admission and other parameters hyponatraemia remained a strong predictor for higher long-term mortality (hazard ratio 1.61; 95% confidence interval 1.32-1.97).Conclusions Patients with incident AMI and hyponatraemia on admission showed a significantly higher risk of long-term mortality than patients without. This strong predictive value was independent of a number of prognostic factors, including diabetes, glomerular filtration rate or reduced LVEF.