Low serum cortisol predicts early death after acute myocardial infarction.
OBJECTIVE
To determine whether low serum cortisol concentrations are associated with adverse prognosis in patients with acute myocardial infarction. Low serum cortisol concentrations have been associated with adverse prognosis in critical illness of diverse etiology.


METHODS
Nested case-control study.


METHODS
Prospective cohort study of consecutive patients admitted with acute myocardial infarction to nine Scottish hospitals.


METHODS
A total of 100 patients who survived 30 days (controls) and 100 patients who died within 30 days (cases).


RESULTS
Admission cortisol concentrations were lower in patients who died than those who survived (median, 1189 nmol/L vs. 1355 nmol/L; p < .001). A cortisol concentration in the bottom quartile (<1136 nmol/L) was a strong predictor of death within 30 days and remained so after adjustment for age and cardiac troponin concentration (adjusted odds ratio, 8.78; 95% confidence interval, 3.09-24.96; p < .001).


CONCLUSIONS
Patients who mount a lesser cortisol stress response to acute myocardial infarction have a poorer early prognosis.
Reynolds
Rebecca M
RM
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Walker
Brian R
BR
Haw
Sally
S
Newby
David E
DE
Mackay
Daniel F
DF
Cobbe
Stuart M
SM
Pell
Alastair C H
AC
Fischbacher
Colin
C
Pringle
Stuart
S
Murdoch
David
D
Dunn
Frank
F
Oldroyd
Keith
K
Macintyre
Paul
P
O'Rourke
Brian
B
Pell
Jill P
JP
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012606:Scotland; D016019:Survival Analysis; D014336:Troponin / Q000097:blood
D014336:Troponin; D006854:Hydrocortisone