Association between serum calcium level and in-hospital mortality in patients with acute myocardial infarction: a retrospective cohort study

The association between serum calcium levels and the prognosis of patients with acute myocardial infarction (AMI) remains controversial. This study aimed to explore the association between serum calcium and in-hospital mortality in patients with AMI. A total of 7284 patients were eventually enrolled in this study, of which 799 (10.97%) died during hospitalization. For each patient, serum calcium, corrected to albumin, was calculated and categorized into four groups: Q1 ≤8.5, Q2 8.5-9.5, Q3 9.5-10.5, and Q4 >10.5 mg/dL. Multivariate analysis demonstrated that corrected sCa was an independent predictor of in-hospital death (Q2 vs. Q1, OR 0.5, 95% CI 0.4-0.7, P<0.001; Q3 vs. Q1, OR 0.8, 95% CI 0.6-1.0, P=0.035; Q4 vs. Q1, OR 1.6, 95% CI 1.1-2.3, P=0.008). The association remained stable in the fully adjusted model. A significant U-shaped association between corrected serum calcium and in-hospital mortality was observed in piecewise linear regression model (Corrected sCa < 9.4 mg/dL, OR 0.8, 95% CI 0.7-0.9, P<0.001; corrected sCa > 9.4 mg/dL, OR 1.5, 95% CI 1.3-1.8, P<0.001). In conclusion, both decreased and increased corrected serum calcium is associated with increased in-hospital mortality in patients with AMI, and patients may have the lowest risk of in-hospital death when corrected serum calcium is 9.4 mg/dL (2.35mmol/L).