Long-term prognostic impact of hyponatremia in the ST-elevation myocardial infarction
Štěpán Havránek1, Jan Bělohlávek, Roman Škulec
12nd Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. stepan.havranek@lf1.cuni.cz
Insights
Reduced serum sodium levels (hyponatremia) in patients with ST-elevation myocardial infarction (STEMI) are linked to worse in-hospital outcomes and increased long-term mortality. Early detection and management of hyponatremia are crucial for improving survival rates.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- ST-elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Serum sodium levels (S-Na) can be affected during acute cardiac events.
- The prognostic value of early hyponatremia in STEMI is not fully understood.
Purpose of the Study:
- To analyze in-hospital outcomes of reduced serum sodium levels (hyponatremia) in STEMI patients.
- To investigate the long-term prognostic implications of early hyponatremia in STEMI.
- To assess the impact of hyponatremia on patients treated with direct percutaneous coronary intervention (dPCI).
Main Methods:
- Retrospective analysis of 218 consecutive STEMI patients without prior heart failure.
- Patients were categorized based on serum sodium levels (hyponatremia < 135 mmol/L) at admission and during hospitalization.
- In-hospital outcomes and long-term survival (mean follow-up 39 months) were compared between hyponatremic and normonatremic groups.
Main Results:
- 33% of STEMI patients developed hyponatremia; 23.4% at admission, 9.6% during hospitalization.
- Hyponatremic patients showed reduced left ventricular function, higher Killip class, and increased risk of cardiogenic shock.
- Patients with late-onset hyponatremia had a higher incidence of acute renal failure.
- Hyponatremia was associated with significantly higher long-term mortality (p = 0.01) and independently predicted total mortality (p = 0.05).
Conclusions:
- Hyponatremia developing in the early phase of STEMI indicates a higher risk of adverse in-hospital outcomes.
- STEMI patients with hyponatremia experience significantly higher mortality rates during long-term follow-up.
- Monitoring and addressing serum sodium levels are important for managing STEMI patients.
Aims:
The aim of the study was to analyse in-hospital outcomes and long-term prognostic implications of reduced sodium serum level (S-Na) in the early phase of ST elevation myocardial infarction (STEMI) treated, primarily, with direct percutaneous coronary intervention (dPCI).
Methods And Results:
The study included 218 consecutive patients (144 males, the mean age 64 ± 13 years) with no history of heart failure admitted with acute STEMI. Out of them, 193 (88.5%) patients were treated with dPCI. The mean follow-up period was 39 ± 21 months. Hyponatremia was defined as S-Na value < 135 mmol/L. A total of 72 (33%) patients reached hyponatremia level; 51(23.4%) of them at admission and 21 (9.6%) later during hospitalization. The hyponatremic patients more frequently presented with reduced left ventricular systolic function, Killip class III or IV and were at increased risk of developing cardiogenic shock compared to patients with normonatremia. Compared to the rest of the population, patients who developed hyponatremia later during hospitalization had higher incidence of acute renal failure; (12 patients/6.1% vs. 5 patients/25.5%, p < 0.05). The difference in long-term survival between the hyponatremia and normonatremia groups was significant (p = 0.01, log-rank test). The multiple analysis of variance identified decrease of S-Na levels at admission independently associated with total mortality (p = 0.05).
Conclusion:
Patients who developed hyponatremia in the early phase of STEMI were at higher risk of worse in-hospital clinical outcome. During the long-term follow-up, higher mortality rates were recorded in hyponatremic patients.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:21Myocarditis I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...