Bae Myung Hwan, Kim Jae Hee, Jang Se Yong, Park Sun Hee, Lee Jang Hoon, Yang Dong Heon, Park Hun Sik, Cho Yongkeun, Chae Shung Chull
Department of Internal Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.
Heart Vessels. 2017 Feb;32(2):126-133. doi: 10.1007/s00380-016-0854-6. Epub 2016 Jun 2.
Hyponatremia in the early phase of acute myocardial infarction (AMI) is a well-known predictor of poor prognosis. However, little is known about the clinical implication of sodium levels at discharge in hospital survivors after AMI. The study included 1290 consecutive patients (64 ± 12 years; 877 men) who survived the index hospitalization after AMI. We determined the 12-month mortality rates of these patients. Patients who died during the 12-month follow-up had lower sodium levels at discharge than those who had survived (137 ± 6 vs. 139 ± 4 mmol/L; P < 0.014). Hyponatremia at discharge, defined as a serum sodium level ≤135 mmol/L, was present in 210 patients (16.3 %). In the Cox-proportional hazard model, hyponatremia at discharge (hazard ratio, 2.264; 95 % confidence interval, 1.119-4.579; P = 0.023) was an independent predictor of 12-month mortality. Moreover, hyponatremia at discharge had an incremental prognostic value over conventional risk factors (χ = 7, P = 0.007), and conventional risk factors and log N-terminal Pro-B-type natriuretic peptide combined (χ = 5, P = 0.021). In the subgroup analysis, the 12-month mortality of patients with hyponatremia at discharge was significantly higher than in those without, irrespective of age, Killip class, left ventricular ejection fraction, percutaneous coronary intervention at index hospitalization, and prescription of diuretics at discharge. Hyponatremia at discharge is an independent predictor of 12-month mortality in hospital survivors after AMI.
急性心肌梗死（AMI）早期的低钠血症是预后不良的一个众所周知的预测指标。然而，关于AMI后出院时钠水平对住院幸存者的临床意义知之甚少。该研究纳入了1290例连续的患者（64±12岁；877例男性），他们在AMI后的首次住院中存活下来。我们确定了这些患者的12个月死亡率。在12个月随访期间死亡的患者出院时的钠水平低于存活患者（137±6 vs. 139±4 mmol/L；P<0.014）。出院时低钠血症定义为血清钠水平≤135 mmol/L，在210例患者（16.3%）中存在。在Cox比例风险模型中，出院时低钠血症（风险比，2.264；95%置信区间，1.119 - 4.579；P = 0.023）是12个月死亡率的独立预测指标。此外，出院时低钠血症比传统危险因素具有更高的预后价值（χ=7，P = 0.007），并且传统危险因素与对数N末端B型利钠肽前体联合使用时也是如此（χ=5，P = 0.021）。在亚组分析中，无论年龄、Killip分级、左心室射血分数、首次住院时的经皮冠状动脉介入治疗以及出院时利尿剂的使用情况如何，出院时低钠血症患者的12个月死亡率均显著高于无低钠血症的患者。出院时低钠血症是AMI后住院幸存者12个月死亡率的独立预测指标。
