European Heart Journal Advance Access originally published online on August 28, 2008
European Heart Journal 2008 29(20):2489-2496; doi:10.1093/eurheartj/ehn383
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Plasma aldosterone levels during hospitalization are predictive of survival post-myocardial infarction
Christchurch Cardioendocrine Research Group, Department of Medicine, Christchurch School of Medicine and Health Sciences, University of Otago, 2 Riccarton Avenue, PO Box 4345, Christchurch 8140, New Zealand
Received 16 April 2008; revised 28 July 2008; accepted 31 July 2008; online publish-ahead-of-print 28 August 2008.
* Corresponding author. Tel: +64 3 378 6232, Fax: +64 3 364 0525, Email: barry.palmer{at}otago.ac.nz
See page 2451 for the editorial comment on this article (doi:10.1093/eurheartj/ehn425)
Aims: Plasma aldosterone levels have been shown to be associated with adverse clinical outcomes after ST-elevation myocardial infarction (STEMI). We investigated whether aldosterone levels in patients presenting with STEMI or non-STEMI, are predictive of mortality during prolonged follow-up.
Methods and results: Aldosterone levels were assayed in plasma taken from 583 patients within 24–96 h following acute myocardial infarction (MI). The median plasma aldosterone level was 108 pmol/L and all values were below the upper limit of the normal range (800 pmol/L) except for five patients (0.9%). Aldosterone tertile was significantly associated with increasing plasma levels of NTproBNP (N-terminal pro-B-type natriuretic peptide), BNP (B-type natriuretic peptide), epinephrine, and endothelin-1 (P 
0.010), but not ANP (atrial natriuretic peptide). Patients in the lowest aldosterone tertile had a significantly better survival, over 5 years’ follow-up, than those in the upper two tertiles (P = 0.0023). Multivariable analysis showed that aldosterone was a significant predictor of survival following adjustment for established predictors (tertile 1 vs. tertile 3; hazard ratio = 2.19, P = 0.018). Patients with above-median levels of both NTproBNP and aldosterone had significantly greater mortality than the remaining patients (above-median 39.8%, other patients 
25.3% mortality, P 0.026).
Conclusion: Plasma aldosterone levels post-MI are independent predictors of survival and hospitalization for heart failure over a 5-year-follow-up period.
Key Words: Myocardial infarction • Hormones • Mortality • Prognosis • Aldosterone
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