Lu Xin, Wang Yunle, Meng Haoyu, Chen Pengsheng, Huang Yaqing, Wang Zemu, Zhou Ningtian, Li Chunjian, Wang Liansheng, Jia Enzhi, Yang Zhijian
Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Gastroenterology, the Drum Tower Hospital of Nanjing Medical University, Nanjing, China.
PLoS One. 2014 Jun 13;9(6):e99895. doi: 10.1371/journal.pone.0099895. eCollection 2014.
The relationship between admission serum calcium levels and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) has not been well definitively explored. The objective was to assess the predictive value of serum calcium levels on in-hospital mortality in STEMI patients.
From 2003 to 2010, 1431 consecutive STEMI patients admitted to the First Affiliated Hospital of Nanjing Medical University were enrolled in the present study. Patients were stratified according to quartiles of serum calcium from the blood samples collected in the emergency room after admission. Between the aforementioned groups,the baseline characteristics, in-hospital management, and in-hospital mortality were analyzed. The association of serum calcium level with in-hospital mortality was calculated by a multivariable Cox regression analysis.
Among 1431 included patients, 79% were male and the median age was 65 years (range, 55-74). Patients in the lower quartiles of serum calcium, as compared to the upper quartiles of serum calcium, were older, had more cardiovascular risk factors, lower rate of emergency revascularization,and higher in-hospital mortality. According to univariate Cox proportional analysis, patients with lower serum calcium level (hazard ratio 0.267, 95% confidence interval 0.164-0.433, p<0.001) was associated with higher in-hospital mortality. The result of multivariable Cox proportional hazard regression analyses showed that the Killip's class≥3 (HR = 2.192, p = 0.026), aspartate aminotransferase (HR = 1.001, p<0.001), neutrophil count (HR = 1.123, p<0.001), serum calcium level (HR = 0.255, p = 0.001), and emergency revascularization (HR = 0.122, p<0.001) were significantly and independently associated with in-hospital mortality in STEMI patients.
Serum calcium was an independent predictor for in-hospital mortality in patients with STEMI. This widely available serum biochemical index may be incorporated into the current established risk stratification model of STEMI patients. Further studies are required to determine the actual mechanism and whether patients with hypocalcaemia could benefit from calcium supplement.
急性ST段抬高型心肌梗死（STEMI）患者入院时血清钙水平与院内死亡率之间的关系尚未得到充分明确的探讨。本研究旨在评估血清钙水平对STEMI患者院内死亡率的预测价值。
2003年至2010年，纳入南京医科大学第一附属医院连续收治的1431例STEMI患者。根据入院后在急诊室采集的血样中血清钙的四分位数对患者进行分层。分析上述各组之间的基线特征、院内治疗情况及院内死亡率。通过多变量Cox回归分析计算血清钙水平与院内死亡率的相关性。
在纳入研究的1431例患者中，79%为男性，中位年龄为65岁（范围55 - 74岁）。血清钙处于较低四分位数的患者与血清钙处于较高四分位数的患者相比，年龄更大，心血管危险因素更多，急诊血运重建率更低，院内死亡率更高。根据单变量Cox比例分析，血清钙水平较低的患者（风险比0.267，95%置信区间0.164 - 0.433，p<0.001）与更高的院内死亡率相关。多变量Cox比例风险回归分析结果显示，Killip分级≥3（HR = 2.192，p = 0.026）、天门冬氨酸氨基转移酶（HR = 1.001，p<0.001）、中性粒细胞计数（HR = 1.123，p<0.001）、血清钙水平（HR = 0.255，p = 0.001）及急诊血运重建（HR = 0.122，p<0.001）与STEMI患者的院内死亡率显著且独立相关。
血清钙是STEMI患者院内死亡率的独立预测因素。这一广泛可用的血清生化指标可纳入当前已建立的STEMI患者风险分层模型。需要进一步研究以确定实际机制以及低钙血症患者是否能从补钙中获益。
