Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Am J Cardiol. 2012 Nov 15;110(10):1419-24. doi: 10.1016/j.amjcard.2012.07.004. Epub 2012 Aug 3.
Whether hyponatremia (sodium <135 mEq/L) in the acute phase of ST-segment elevation myocardial infarction is just a marker of "more ill" patients or decreased sodium concentration is able to exert a direct adverse effect on the cardiovascular system is still unknown. The aim of this study was to assess the prognostic impact, in the short and long terms, of admission hyponatremia in 1,231 consecutive patients with ST-segment elevation myocardial infarctions all submitted to primary percutaneous coronary intervention. In this series, 286 patients (23.2%) had sodium values <135 mEq/L. Patients with hyponatremia were older (p = 0.018) and more frequently had diabetes (p = 0.040). Anterior myocardial infarction was more frequent in patients with hyponatremia, who showed a higher incidence of 3-vessel coronary artery disease and advanced Killip class. Higher mortality rates were observed in patients with hyponatremia during intensive cardiac care unit stay and at follow-up. On multivariate regression analysis, admission sodium concentration was not independently related to early death, nor did it show any relations with long-term mortality on Cox regression analysis. In conclusion, the main findings of the present investigation are as follows: (1) hyponatremia is a common finding, being associated mainly with older age, diabetes, and advanced Killip class; (2) patients with hyponatremia had higher rates of in-hospital and long-term mortality; and (3) hyponatremia, also when assessed by means of the propensity score model, was not independently associated with increased risk for death in the short and long terms. These data therefore strongly suggest that the presence of hyponatremia in the acute phase of ST-segment elevation myocardial infarction should be considered a marker of more ill patients.
在 ST 段抬高型心肌梗死的急性期，低钠血症（血清钠<135mEq/L）是否仅仅是“病情更重”患者的标志物，或者低钠血症浓度是否能够对心血管系统产生直接的不良影响仍不清楚。本研究旨在评估在 1231 例接受直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者中，入院时低钠血症对短期和长期预后的影响。在本系列中，286 例（23.2%）患者的血清钠值<135mEq/L。低钠血症患者年龄较大（p=0.018），且更常患有糖尿病（p=0.040）。低钠血症患者前壁心肌梗死更为常见，且三支血管病变和较高的 Killip 分级更为常见。在重症监护病房住院期间和随访期间，低钠血症患者的死亡率更高。多变量回归分析显示，入院时血清钠浓度与早期死亡无关，在 Cox 回归分析中也与长期死亡率无关。总之，本研究的主要发现如下：（1）低钠血症是一种常见的发现，主要与年龄较大、糖尿病和较高的 Killip 分级有关；（2）低钠血症患者住院期间和长期死亡率较高；（3）即使通过倾向评分模型评估，低钠血症与短期和长期死亡风险增加也无关。这些数据强烈表明，在 ST 段抬高型心肌梗死的急性期存在低钠血症应被视为病情更重的标志物。
