Department of Cardiology, University Hospital, Lille, France.
Eur Heart J. 2012 Jan;33(2):191-202. doi: 10.1093/eurheartj/ehr176. Epub 2011 Jun 30.
Recent studies have demonstrated that aldosterone levels measured in patients with heart failure or acute myocardial infarction (MI) are associated with long-term mortality, but the association with aldosterone levels in patients with coronary artery disease (CAD) outside these specific settings remains unknown. In addition, no clear mechanism has been elucidated to explain these observations. The present study was designed to evaluate the relationship between the level of aldosterone and the risk of death and acute ischaemic events in CAD patients with a preserved left ventricular (LV) function and no acute MI.
In 799 consecutive CAD patients referred for elective coronary angioplasty measurements were obtained before the procedure for: aldosterone (median = 25 pg/mL), brain natriuretic peptide (BNP) (median = 35 pg/mL), hsC-reactive protein (median = 4.17 mg/L), and left ventricular ejection fraction (mean = 58%). Patients with acute MI or coronary syndrome (ACS) who required urgent revascularization were not included in the study. The primary endpoint, cardiovascular death, occurred in 41 patients during a median follow-up period of 14.9 months. Secondary endpoints-total mortality, acute ischaemic events (acute MI or ischaemic stroke), and the composite of death and acute ischaemic events-were observed in 52, 54, and 94 patients, respectively. Plasma aldosterone was found to be related to BMI, hypertension and NYHA class, and inversely related to age, creatinine clearance, and use of beta-blockers. Multivariate Cox model analysis demonstrated that aldosterone was independently associated with cardiovascular mortality (P = 0.001), total mortality (P = 0.001), acute ischaemic events (P = 0.01), and the composite of death and acute ischaemic events (P = 0.004). Reclassification analysis, using integrated discrimination improvement (IDI) and net reclassification improvement (NRI), demonstrated incremental predictive value of aldosterone (P < 0.0001).
Our results demonstrate that, in patients with CAD but without heart failure or acute MI, the level of aldosterone is strongly and independently associated with mortality and the occurrence of acute ischaemic events.
最近的研究表明，心力衰竭或急性心肌梗死（MI）患者的醛固酮水平与长期死亡率相关，但在这些特定情况下之外，冠心病（CAD）患者的醛固酮水平与死亡率的相关性仍不清楚。此外，尚未阐明明确的机制来解释这些观察结果。本研究旨在评估在左心室（LV）功能正常且无急性 MI 的 CAD 患者中，醛固酮水平与死亡和急性缺血性事件风险之间的关系。
在 799 例连续的 CAD 患者中，在选择性冠状动脉成形术之前进行了以下测量：醛固酮（中位数= 25 pg/mL）、脑钠肽（BNP）（中位数= 35 pg/mL）、高敏 C 反应蛋白（hsC-反应蛋白）（中位数= 4.17 mg/L）和左心室射血分数（均值= 58%）。未包括在研究中的患者为有急性 MI 或冠状动脉综合征（ACS）需要紧急血运重建的患者。主要终点，心血管死亡，在中位随访 14.9 个月期间发生在 41 例患者中。次要终点-总死亡率、急性缺血性事件（急性 MI 或缺血性中风）和死亡与急性缺血性事件的复合终点-分别在 52、54 和 94 例患者中观察到。发现血浆醛固酮与 BMI、高血压和 NYHA 分级相关，与年龄、肌酐清除率和β受体阻滞剂的使用呈负相关。多变量 Cox 模型分析表明，醛固酮与心血管死亡率（P=0.001）、总死亡率（P=0.001）、急性缺血性事件（P=0.01）和死亡与急性缺血性事件的复合终点（P=0.004）独立相关。使用综合判别改善（IDI）和净再分类改善（NRI）的重新分类分析表明，醛固酮具有增量预测价值（P<0.0001）。
我们的结果表明，在没有心力衰竭或急性 MI 的 CAD 患者中，醛固酮水平与死亡率和急性缺血性事件的发生密切相关且独立相关。
