Plasma cortisol and prognosis of patients with acute myocardial infarction.
OBJECTIVE
Cortisol is associated with increased cardiovascular morbidity and mortality in patients with chronic heart failure and in the general population. The negative predictive effect of cortisol on survival in non-diabetic patients who have suffered an acute myocardial infarction (AMI) has been shown. We aimed to determine the prognostic significance of cortisol in a general group of AMI patients, as this is not well known.


METHODS
Plasma cortisol levels were measured in 955 consecutive patients admitted with AMI. We prospectively evaluated the relationship between cortisol and major adverse cardiovascular event (MACE), which was a composite of all-cause mortality, and combination all-cause mortality and re-hospitalization for heart failure, in post-AMI patients.


RESULTS
During the 2-year follow-up, MACE occurred in 261 patients (27.3%). Patients with MACE had significantly higher median levels of cortisol than those without (609.4 versus 549.4 pmol/ml, P = 0.0073). Log cortisol was independently predictive of MACE after adjusting for covariates with hazard ratio (95% confidence interval) of 1.55 (1.05-2.27), P = 0.027. Patients in the highest quartile of cortisol had significantly more risk of MACE compared with those in the lowest quartile, with an adjusted hazard ratio (95% confidence interval) of 1.91(1.16-3.15), P = 0.0120. Kaplan-Meier survival estimates for MACE were lower in patients with plasma cortisol levels in the highest quartile compared with those in the first three quartiles (Log rank test χ² for survival = 10.41, P = 0.0013).


CONCLUSIONS
This study has shown the prognostic significance of cortisol in 955 post-AMI patients from a single centre.
aDepartment of Cardiovascular Sciences, University of Leicester bNIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK *Sandeep K. Jutla and Matthew F. Yuyun contributed equally to the writing of the article.
Sandeep K
SK
Jutla
Matthew F
MF
Yuyun
Paulene A
PA
Quinn
Leong L
LL
Ng
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000209:etiology / Q000401:mortality; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D010343:Patient Admission; D010359:Patient Readmission; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D015854:Up-Regulation
D015415:Biomarkers; D006854:Hydrocortisone