| Background and objectiveCardiovascular disease is one of the main diseases that threatening human's health. Epidemiological survey found that from 2014 to 2015, there are 22% middle-agaed patients died of cardiovascular disease, while the United States is 12%. Coronary atherosclerotic heart disease(coronary heart disease, CHD) is the most clinical common disease of cardiovascular disease. In recent years, people's lifestyle have greatly changed and the environmental problem is becoming more and more serious. As a result, the prevalence rate of CHD has a rising trend, and the patients are becoming younger. These have serious impact on human's life quality and survival rate. Acute myocardial infarction(AMI) is one of the most server heart disease. It's morbidity has increased in recent years. As we all know that AMI is the most common causes of sudden cardiac death. So early reperfusion therapy, reasonable medication and active intervention of risk factor are essential in order to reduce the mortality of patients and improve the quality of life as well as reduce the burden of patients. A large number of studies have found that the prognostic impact of AMI is influenced by many factors, such as age, severity of coronary artery disease and basic diseases and so on. But there are still many risk factors are controversial or not be found. Hyponatremia is a common electrolyte disorder. Patients with heart failure, cirrhosis, renal insufficiency and in the postoperative period often suffer from hyponatremia, and it has been recognized as a predictor of bad outcomes among hospitalized patients. At the same time, many studies has shown that hyponatremia is a predictor of cardiovascular mortality in patients with heart failure. While the prognostic value of hyponatremia in the setting of acute ST-elevation myocardial infarction(STEMI) are lacking. Therefore we aimed at studying the prevalence of hyponatremia during the acute phase of STEMI, finding its prognostic implications in 30 days and futher exploring the relationship between hyponatremia and adverse cardiovascular event after acute ST-elevation myocardial infarction. MethodThe study sample consisted of 223 consecutive patients with acute ST-elevation myocardial infarction in the cardiovascular department of first affiliated hosPital of zhengzhou university from March 2014 to May 2015. Plasma sodium concentrations were obtained at 24,48,72 hours thereafter. According to the plama soudium level,patients were divided into three groups(normal sodium level, hyponatremia on admission, hyponatremia within 72 hours). Hyponatremia is defined as a plasma sodium level <135mmol/L. Age, sex, blood pressure, Killip class, hemoglobin,ejection fraction, reperfusion therapy were compared between three groups, then observe the morbidity of acute renal failure, cardiac shock,ventricular aneurysm formation, ventricular septal and other complications between three groups. The data were analysed by SPSS17.0. Result1.Compared with normal sodium level group, both hyponatremia on admission or early development of hyponatremia patients were older, had higher blood glucose and hemoglobin, lower ejection fraction and poorer heart function(P<0.05).2.Compared with normal sodium level group, the mortality of hyponatremia group was higher and was more often to had cardiac shock, acute renal disfunction, left ventricular aneurysm(P<0.05).3.The risk of 30-day mortality increased with the severity of hyponatremia,with an odds ratio of 2.0 in patients with sodium levels between 130 and 134mmol/L(95%CI:1.1 to 3.4; P=0.006), and 3.3 in those with levels < 130mmol/L(95%CI:1.4 to 7.7; P=0.003).4. Multivariate logistic regression analyses shown that hyponatremia in patients with acute ST-elevation myocardial infarction is an independent predictor of short term mortality and the risk of 30-day mortality increased with the severity of hyponatremia. Conclusion1. The elderly, higher Killip grade, lower EF value, did not receive reperfusion therapy are bad factors that influence the prognostic in patients with acute myocardial infarction.2. Hyponatremia on admission or early development of hyponatremia in patients with acute ST-elevation myocardial infarction is an independent predictor of 30-day mortality, and prognosis worsens with the severity of hyponatremia.3.Compared with normal sodium level group, patients with hyponatremia were more often to had cardiac shock, acute renal disfunction, left ventricular aneurysm and so on.4.Serum sodium concentration may be used as an early indicator to identify the severity of disease in patients with STEMI. |
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