Plasma cortisol and prognosis of patients with acute myocardial infarction.

Abstract

Aims: Cortisol is associated with increased cardiovascular morbidity and mortality in patients with chronic heart failure and in the general population. The negative predictive effect of cortisol on survival in non-diabetic patients who have suffered an acute myocardial infarction (AMI) has been shown. We aimed to determine the prognostic significance of cortisol in a general group of AMI patients, as this is not well known. Methods: Plasma cortisol levels were measured in 955 consecutive patients admitted with AMI. We prospectively evaluated the relationship between cortisol and major adverse cardiovascular event (MACE), which was a composite of all-cause mortality, and combination all-cause mortality and re-hospitalization for heart failure, in post-AMI patients. Results: During the 2-year follow-up, MACE occurred in 261 patients (27.3%). Patients with MACE had significantly higher median levels of cortisol than those without (609.4 versus 549.4 pmol/ml, P = 0.0073). Log cortisol was independently predictive of MACE after adjusting for covariates with hazard ratio (95% confidence interval) of 1.55 (1.05-2.27), P = 0.027. Patients in the highest quartile of cortisol had significantly more risk of MACE compared with those in the lowest quartile, with an adjusted hazard ratio (95% confidence interval) of 1.91(1.16-3.15), P = 0.0120. Kaplan-Meier survival estimates for MACE were lower in patients with plasma cortisol levels in the highest quartile compared with those in the first three quartiles (Log rank test χ² for survival = 10.41, P = 0.0013). Conclusion: This study has shown the prognostic significance of cortisol in 955 post-AMI patients from a single centre.

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