Association of Admission Serum Calcium Levels and In-Hospital Mortality in Patients with Acute ST-Elevated Myocardial Infarction: An Eight-Year, Single-Center Study in China

Abstract

ObjectiveThe 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.MethodsFrom 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.ResultsAmong 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.ConclusionsSerum 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.

Serum Calcium and Risk of Sudden Cardiac Arrest in the General Population

“…Similarly, Miura et al reviewed patients with heart failure and chronic kidney disease and reported that cardiac and all-cause mortality was significantly higher in the low-Ca group compared to the normal-high Ca group 27 . Finally, in patients with ST-elevated myocardial infarction lower Ca levels at the time of admission were associated with higher in-hospital mortality 28 . An important caveat to majority of the above mentioned studies is the focus on overall cardiovascular disease mortality, with limited data on association of Ca levels specifically with SCA.…”

“…Ca intake or level has mainly been studied in relation to bone health and in regards to its supplementation and cardiovascular safety 18 . Nevertheless, multiple cohort studies with long duration of follow up using baseline Ca levels have investigated the association of Ca serum levels and cardiovascular or all-cause mortality in different populations and subgroups 19–28 . These reports demonstrated conflicting results, with both high and low levels of Ca reported to be associated with increase in cardiovascular events.…”

Admission Serum Calcium Levels Improve the GRACE Risk Score Prediction of Hospital Mortality in Patients With Acute Coronary Syndrome

“…7,8 Recently, hypocalcemia has been reported to be a predictor of increased in-hospital mortality in patients with severe coronary artery disease (CAD). 9 However, the association between serum calcium and the GRACE score remains unclear to date.…”

Cardiovascular Calcification and Bone: A Comparison of The Effects of Dietary and Serum Calcium, Phosphorous, Magnesium and Vitamin D

“…Many studies of serum calcium show no association with calcification [21][22][23][24][25] , although some show a positive correlation with presence, extent and progression of AAC in older adults 19,[26][27] , with mixed results for presence of CAC, although there may be an association with extent or progression [18][19][28][29] . Serum calcium was an independent predictor of calcified and mixed plaque but not non-calcified plaque 29 and higher concentrations were associated with lower in-hospital mortality among MI patients 30 . Nevertheless, serum calcium levels often bear little relationship to intake, as is evidenced by the study by Wang et al, where higher serum calcium was associated with increased AAC but a higher calcium intake was found in those with no AAC 19 .…”