Prognostic role of aldosterone in patients with acute coronary syndrome: short and medium term follow-up.

Aims: Different studies have shown a correlation between aldosterone, atherosclerosis and ischemia in the past decade. Evidence exists for the relationship between high levels of aldosterone and augmented risk of cardiovascular diseases, such as hypertension, cardiac failure, coronary artery disease and stroke. The objective of this study was to determine the prognostic role of aldosterone in patients with myocardial infarction.

Methods: The study population included 96 consecutive patients admitted to our department for ST-elevated and non-ST-elevated myocardial infarction from June 2009 to March 2012. Plasma aldosterone levels were measured at admission to hospital in all patients. A 2-year prospective follow-up was performed, and fatal events and non-fatal events, such as reinfarction, congestive heart failure and arrhythmias, were recorded.

Results: Aldosterone levels at admission were associated with incidence of congestive heart failure (P = 0.02), ventricular arrhythmias (P = 0.01) and all complications (P = 0.003) after 1-month follow-up. Moreover, high aldosterone levels gave important information in the medium term (24 ± 6 months). Specifically, aldosterone was a predictive variable of reinfarction (P < 0.0001), congestive heart failure (P < 0.0001) and adverse events (P = 0.0002). The logistic regression analysis confirmed these results and showed that aldosterone may be predictive of adverse events at medium-term follow-up (odds ratio 1.1, 95% confidence interval 1.03-1.15, P = 0.02).

Conclusion: These data show a strong and significant correlation between plasma aldosterone levels at admission for myocardial infarction and fatal and nonfatal adverse events. Aldosterone appears to be a main marker of adverse clinical outcome, in accordance with the literature. These data suggest the need to identify whether antialdosteronic drug treatment, applied acutely in patients with aldosterone elevation, can influence favorably the prognosis of patients with myocardial infarction.