Shiyovich A, Plakht Y, Gilutz H
Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, and "Sackler" Faculty of Medicine, Tel-Aviv University, Israel.
Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Nutr Metab Cardiovasc Dis. 2018 May;28(5):510-516. doi: 10.1016/j.numecd.2018.01.013. Epub 2018 Feb 1.
Serum calcium levels (sCa) were reported to be associated with cardiovascular risk factors, incidence of coronary artery disease and acute myocardial infarction (AMI). The current study evaluated the association between sCa and in-hospital mortality among AMI patients.
Patients admitted in a tertiary medical center for AMI throughout 2002-2012 were analyzed. For each patient, mean sCa, corrected to albumin, was calculated and categorized to seven equally-sized groups: <8.9, 8.9-9.12, 9.12-9.3, 9.3-9.44, 9.44-9.62, 9.62-9.86, ≥9.86 mg/dL. The primary outcome was all-cause in-hospital mortality. Out of 12,121 AMI patients, 11,446 were included, mean age 67.1 ± 14 years, 68% Males. Mean number of sCa values for patient was 4.2 ± 7.3. Mean sCa was 9.4 ± 0.53 mg/dL, range 5.6-13.2 mg/dL sCa was significantly associated with cardiovascular risk-factors, in-hospital complications, more frequent 3-vessel coronary artery disease and decreased rate of revascularization, often in a U-shaped association. Overall 794 (6.9%) patients died in-hospital. Multivariate analysis showed a significant U-shaped association between sCa and in-hospital mortality with sCa below 9.12 mg/dL and above 9.86 mg/dL as independent predictors of significantly increased in-hospital mortality: OR = 2.4 (95% CI:1.7-3.3) and 1.7 (95%CI:1.2-2.4), for Ca<8.9 and Ca≥9.86 mg/dL respectively p < 0.01, as compared with middle rage sCa group (9.3-9.44 mg/dL).
sCa is an independent predictor of in-hospital mortality in patients with AMI with a U-shaped association. Both increased and decreased sCa levels are associated with increased risk of in-hospital mortality.
血清钙水平（sCa）据报道与心血管危险因素、冠状动脉疾病发病率及急性心肌梗死（AMI）相关。本研究评估了AMI患者中sCa与院内死亡率之间的关联。
对2002年至2012年期间在一家三级医疗中心因AMI入院的患者进行分析。计算每位患者校正白蛋白后的平均sCa，并将其分为七个等分组：<8.9、8.9 - 9.12、9.12 - 9.3、9.3 - 9.44、9.44 - 9.62、9.62 - 9.86、≥9.86mg/dL。主要结局为全因院内死亡率。在12121例AMI患者中，纳入了11446例，平均年龄67.1±14岁，男性占68%。患者的sCa值平均数量为4.2±7.3。平均sCa为9.4±0.53mg/dL，范围为5.6 - 13.2mg/dL。sCa与心血管危险因素、院内并发症、更常见的三支冠状动脉疾病及血运重建率降低显著相关，且通常呈U形关联。总体有794例（6.9%）患者在院内死亡。多因素分析显示，sCa与院内死亡率之间存在显著的U形关联，sCa低于9.12mg/dL及高于9.86mg/dL是院内死亡率显著增加的独立预测因素：对于Ca<8.9mg/dL和Ca≥9.86mg/dL，OR分别为2.4（95%CI：1.7 - 3.3）和1.7（95%CI：1.2 - 2.4），与中间范围sCa组（9.3 - 9.44mg/dL）相比，p<0.01。
sCa是AMI患者院内死亡率的独立预测因素，呈U形关联。sCa水平的升高和降低均与院内死亡风险增加相关。
