Aldosterone and long-term outcome after myocardial infarction: A substudy of the French nationwide Observatory for hospital care, the Development in one year and the characteristics of patients presenting with myocardial infarction with or without Q wave (OPERA) study

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. © 2009 Mosby, Inc. All rights reserved.