title: Low serum cortisol predicts early death after acute myocardial infarction.
abstract: 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.
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Reynolds
authors.forename: Brian R
authors.initials: BR
authors.lastname: Walker
authors.forename: Sally
authors.initials: S
authors.lastname: Haw
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Mackay
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Cobbe
authors.forename: Alastair C H
authors.initials: AC
authors.lastname: Pell
authors.forename: Colin
authors.initials: C
authors.lastname: Fischbacher
authors.forename: Stuart
authors.initials: S
authors.lastname: Pringle
authors.forename: David
authors.initials: D
authors.lastname: Murdoch
authors.forename: Frank
authors.initials: F
authors.lastname: Dunn
authors.forename: Keith
authors.initials: K
authors.lastname: Oldroyd
authors.forename: Paul
authors.initials: P
authors.lastname: Macintyre
authors.forename: Brian
authors.initials: B
authors.lastname: O'Rourke
authors.forename: Jill P
authors.initials: JP
authors.lastname: Pell
mesh_terms: 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
chemical_list: D014336:Troponin; D006854:Hydrocortisone