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Aldosterone and long-term outcome after myocardial infarction : A substudy of the french nationwide Observatoire sur la Prise en charge hospitalière, l'Evolution à un an et les caRactéristiques de patients présentant un infArctus du myocarde avec ou sans onde Q (OPERA) study

Identifieur interne : 000204 ( PascalFrancis/Checkpoint ); précédent : 000203; suivant : 000205

Aldosterone and long-term outcome after myocardial infarction : A substudy of the french nationwide Observatoire sur la Prise en charge hospitalière, l'Evolution à un an et les caRactéristiques de patients présentant un infArctus du myocarde avec ou sans onde Q (OPERA) study

Auteurs : Farzin Beygui [France] ; Gilles Montalescot [France] ; Eric Vicaut [France] ; Stephanie Rouanet [France] ; Eric Van Belle [France] ; Cathrine Baulac [France] ; Alexia Degrandsart [France] ; Jean Dallongeville [France]

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RBID : Pascal:09-0215048

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English descriptors

Abstract

Background High plasma aldosterone levels at presentation are correlated to poor outcome after ST elevation acute myocardial infarction (AMI). Whether there is a relationship between aldosterone levels and outcome in a broader spectrum of patients admitted for AMI defined by the new definition based on troponin levels remains unknown. Methods Plasma aldosterone, C-reactive protein, and brain natriuretic peptide (BNP) were measured in 471 patients, 24 and 72 hours after admission for AMI defined by the new definition. The primary outcome was the composite of death, resuscitated cardiac arrest, recurrent/extended myocardial infarction, recurrent ischemia, heart failure, and stroke. Results The highest aldosterone levels quartile at 24 hours was significantly associated with the occurrence of the primary outcome (P <.0001), death (P <.05), heart failure (P <.05), ventricular (P <.0001) and supraventricular arrhythmias (P <.05), and acute renal failure (P <.01) during the in-hospital period, and higher rates of mortality (P < .05) at 1-year follow-up. Independent correlates of the primary outcome at 1 year were age >73 (odds ratio [OR] 2.22 [1.38-3.57]), heart failure (OR 6.46 [1.99-20.98]), 24-hour aldosterone ≥103.6 pg.mL-1 (OR 1.72 [1.07-2.77]), and BNP >389 pg.mL-1 (OR 2.35 [1.44-3.84]) concentrations. The model applied to the 72-hour variables, identified the same correlates. Conclusions Using the new definition of AMI, based on troponin levels, regardless of ST-segment elevation and management strategies, high aldosterone concentration is associated with major adverse in-hospital events and is an independent correlate of clinical outcome at 1 year. These findings warrant trials assessing the benefit of early aldosterone blockade in such patients.


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Pascal:09-0215048

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<term>Aldosterone</term>
<term>Cardiology</term>
<term>Cardiovascular disease</term>
<term>Circulatory system</term>
<term>Evolution</term>
<term>Human</term>
<term>Long term</term>
<term>Myocardial infarction</term>
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<term>Infarctus du myocarde</term>
<term>Pathologie de l'appareil circulatoire</term>
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<term>Long terme</term>
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<term>Evolution</term>
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<div type="abstract" xml:lang="en">Background High plasma aldosterone levels at presentation are correlated to poor outcome after ST elevation acute myocardial infarction (AMI). Whether there is a relationship between aldosterone levels and outcome in a broader spectrum of patients admitted for AMI defined by the new definition based on troponin levels remains unknown. Methods Plasma aldosterone, C-reactive protein, and brain natriuretic peptide (BNP) were measured in 471 patients, 24 and 72 hours after admission for AMI defined by the new definition. The primary outcome was the composite of death, resuscitated cardiac arrest, recurrent/extended myocardial infarction, recurrent ischemia, heart failure, and stroke. Results The highest aldosterone levels quartile at 24 hours was significantly associated with the occurrence of the primary outcome (P <.0001), death (P <.05), heart failure (P <.05), ventricular (P <.0001) and supraventricular arrhythmias (P <.05), and acute renal failure (P <.01) during the in-hospital period, and higher rates of mortality (P < .05) at 1-year follow-up. Independent correlates of the primary outcome at 1 year were age >73 (odds ratio [OR] 2.22 [1.38-3.57]), heart failure (OR 6.46 [1.99-20.98]), 24-hour aldosterone ≥103.6 pg.mL
<sup>-1</sup>
(OR 1.72 [1.07-2.77]), and BNP >389 pg.mL
<sup>-1</sup>
(OR 2.35 [1.44-3.84]) concentrations. The model applied to the 72-hour variables, identified the same correlates. Conclusions Using the new definition of AMI, based on troponin levels, regardless of ST-segment elevation and management strategies, high aldosterone concentration is associated with major adverse in-hospital events and is an independent correlate of clinical outcome at 1 year. These findings warrant trials assessing the benefit of early aldosterone blockade in such patients.</div>
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<sup>-1</sup>
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<sup>-1</sup>
(OR 2.35 [1.44-3.84]) concentrations. The model applied to the 72-hour variables, identified the same correlates. Conclusions Using the new definition of AMI, based on troponin levels, regardless of ST-segment elevation and management strategies, high aldosterone concentration is associated with major adverse in-hospital events and is an independent correlate of clinical outcome at 1 year. These findings warrant trials assessing the benefit of early aldosterone blockade in such patients.</s0>
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<s0>Pronostic</s0>
<s5>11</s5>
</fC03>
<fC03 i1="05" i2="X" l="ENG">
<s0>Prognosis</s0>
<s5>11</s5>
</fC03>
<fC03 i1="05" i2="X" l="SPA">
<s0>Pronóstico</s0>
<s5>11</s5>
</fC03>
<fC03 i1="06" i2="X" l="FRE">
<s0>Evolution</s0>
<s5>12</s5>
</fC03>
<fC03 i1="06" i2="X" l="ENG">
<s0>Evolution</s0>
<s5>12</s5>
</fC03>
<fC03 i1="06" i2="X" l="SPA">
<s0>Evolución</s0>
<s5>12</s5>
</fC03>
<fC03 i1="07" i2="X" l="FRE">
<s0>Homme</s0>
<s5>13</s5>
</fC03>
<fC03 i1="07" i2="X" l="ENG">
<s0>Human</s0>
<s5>13</s5>
</fC03>
<fC03 i1="07" i2="X" l="SPA">
<s0>Hombre</s0>
<s5>13</s5>
</fC03>
<fC03 i1="08" i2="X" l="FRE">
<s0>Appareil circulatoire</s0>
<s5>14</s5>
</fC03>
<fC03 i1="08" i2="X" l="ENG">
<s0>Circulatory system</s0>
<s5>14</s5>
</fC03>
<fC03 i1="08" i2="X" l="SPA">
<s0>Aparato circulatorio</s0>
<s5>14</s5>
</fC03>
<fC03 i1="09" i2="X" l="FRE">
<s0>Cardiologie</s0>
<s5>15</s5>
</fC03>
<fC03 i1="09" i2="X" l="ENG">
<s0>Cardiology</s0>
<s5>15</s5>
</fC03>
<fC03 i1="09" i2="X" l="SPA">
<s0>Cardiología</s0>
<s5>15</s5>
</fC03>
<fC07 i1="01" i2="X" l="FRE">
<s0>Cardiopathie coronaire</s0>
<s5>37</s5>
</fC07>
<fC07 i1="01" i2="X" l="ENG">
<s0>Coronary heart disease</s0>
<s5>37</s5>
</fC07>
<fC07 i1="01" i2="X" l="SPA">
<s0>Cardiopatía coronaria</s0>
<s5>37</s5>
</fC07>
<fC07 i1="02" i2="X" l="FRE">
<s0>Pathologie du myocarde</s0>
<s5>38</s5>
</fC07>
<fC07 i1="02" i2="X" l="ENG">
<s0>Myocardial disease</s0>
<s5>38</s5>
</fC07>
<fC07 i1="02" i2="X" l="SPA">
<s0>Miocardio patología</s0>
<s5>38</s5>
</fC07>
<fN21>
<s1>159</s1>
</fN21>
<fN44 i1="01">
<s1>OTO</s1>
</fN44>
<fN82>
<s1>OTO</s1>
</fN82>
</pA>
</standard>
</inist>
<affiliations>
<list>
<country>
<li>France</li>
</country>
<settlement>
<li>Lille</li>
<li>Paris</li>
</settlement>
</list>
<tree>
<country name="France">
<noRegion>
<name sortKey="Beygui, Farzin" sort="Beygui, Farzin" uniqKey="Beygui F" first="Farzin" last="Beygui">Farzin Beygui</name>
</noRegion>
<name sortKey="Baulac, Cathrine" sort="Baulac, Cathrine" uniqKey="Baulac C" first="Cathrine" last="Baulac">Cathrine Baulac</name>
<name sortKey="Dallongeville, Jean" sort="Dallongeville, Jean" uniqKey="Dallongeville J" first="Jean" last="Dallongeville">Jean Dallongeville</name>
<name sortKey="Degrandsart, Alexia" sort="Degrandsart, Alexia" uniqKey="Degrandsart A" first="Alexia" last="Degrandsart">Alexia Degrandsart</name>
<name sortKey="Montalescot, Gilles" sort="Montalescot, Gilles" uniqKey="Montalescot G" first="Gilles" last="Montalescot">Gilles Montalescot</name>
<name sortKey="Rouanet, Stephanie" sort="Rouanet, Stephanie" uniqKey="Rouanet S" first="Stephanie" last="Rouanet">Stephanie Rouanet</name>
<name sortKey="Van Belle, Eric" sort="Van Belle, Eric" uniqKey="Van Belle E" first="Eric" last="Van Belle">Eric Van Belle</name>
<name sortKey="Vicaut, Eric" sort="Vicaut, Eric" uniqKey="Vicaut E" first="Eric" last="Vicaut">Eric Vicaut</name>
</country>
</tree>
</affiliations>
</record>

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