title: High plasma aldosterone levels on admission are associated with death in patients presenting with acute ST-elevation myocardial infarction.
abstract: 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.
  
  
  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.
authors.affiliation: Cardiology Department and INSERM U 856, Pitié-Salpêtrière University Hospital, Paris, France.
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Collet
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Benoliel
authors.forename: Nicolas
authors.initials: N
authors.lastname: Vignolles
authors.forename: Raphaelle
authors.initials: R
authors.lastname: Dumaine
authors.forename: Olivier
authors.initials: O
authors.lastname: Barthélémy
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D000450:Aldosterone