Key result
Admission serum cortisol in the bottom quartile (<1136 nmol/L) after acute myocardial infarction strongly predicted death within 30 days (adjusted OR 8.78; 95% CI 3.09-24.96; p<.001).
Why the study?
Does low admission serum cortisol predict 30-day mortality in patients with acute myocardial infarction?
Case-Control (n=200)
Yes
Does low admission serum cortisol predict 30-day mortality in patients with acute myocardial infarction?
Odds Ratio: 8.78 (95% CI 3.09–24.96)
p-value: p=<.001
A blunted cortisol stress response (low serum cortisol) upon admission for acute myocardial infarction is a strong independent predictor of 30-day mortality.
May flag high-risk AMI patients; hypothesis-generating and requires prospective validation before clinical use.
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. DESIGN: Nested case-control study. SETTING: Prospective cohort study of consecutive patients admitted with acute myocardial infarction to nine Scottish hospitals. PATIENTS: A total of 100 patients who survived 30 days (controls) and 100 patients who died within 30 days (cases). MEASUREMENTS AND MAIN 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.
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Reynolds et al. (2010) conducted a case-control in acute myocardial infarction (n=200). Low serum cortisol concentration vs. Higher serum cortisol concentration was evaluated on Death within 30 days (adjusted OR 8.78, 95% CI 3.09-24.96, p=<.001). Admission serum cortisol in the bottom quartile (<1136 nmol/L) after acute myocardial infarction strongly predicted death within 30 days (adjusted OR 8.78; 95% CI 3.09-24.96; p<.001).
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