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(Circulation. 2006;114:2604-2610.)
© 2006 American Heart Association, Inc.

Coronary Heart Disease

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

Farzin Beygui, MD, PhD; Jean-Philippe Collet, MD, PhD; Jean-Jacques Benoliel, MD, PhD; Nicolas Vignolles, BSc; Raphaelle Dumaine, MD; Olivier Barthélémy, MD; Gilles Montalescot, MD, PhD

From Cardiology Department and INSERM U 856 (F.B., J.-P.C., N.V., R.D., O.B., G.M.) and Biochemistry Laboratory (J.-J.B.), INSERM U 713, Pitié-Salpêtrière University Hospital, Paris, France.

Correspondence to Professor Gilles Montalescot, Institut de Cardiologie, Bureau 2-236, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47-83, Bd de l’Hôpital, 75013 Paris, France. E-mail gilles.montalescot{at}psl.aphp.fr

Received April 18, 2006; revision received September 12, 2006; accepted September 29, 2006.

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 (P=0.01), cardiovascular death (P=0.03), heart failure (P=0.005), ventricular fibrillation (P=0.02), and resuscitated cardiac arrest (P=0.01). 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, P=0.035) and death or resuscitated cardiac arrest (hazard ratio 3.74, 95% CI 1.40 to 9.98, P=0.008) 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.

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