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Alexander Goldberg, MD; Haim Hammerman, MD; Sirouch Petcherski, MD; Mithal Nassar, MD; Alexander Zdorovyak, MD; Sergey Yalonetsky, MD; Michael Kapeliovich, MD, PhD; Yoram Agmon, MD; Rafael Beyar, MD, DSc; Walter Markiewicz, MD; Doron Aronson, MD

Arch Intern Med. 2006;166:781-786.

Background  Hyponatremia, a marker of neurohormonal activation, is a common electrolyte disorder among patients with acute ST-elevation myocardial infarction. The long-term prognostic value of hyponatremia during the acute phase of infarction is not known.

Methods  We studied 978 patients with acute ST-elevation myocardial infarction and without a history of heart failure who survived the index event. During the hospital stay, sodium levels were obtained on admission and at 24, 48, and 72 hours. The median duration of follow-up after hospital discharge was 31 months (range, 9-61 months).

Results  Hyponatremia, defined as a mean serum sodium level less than 136 mEq/L, was present during admission in 108 patients (11.0%). In a multivariable Cox proportional hazards model adjusting for other potential clinical predictors of mortality and for left ventricular ejection fraction, hyponatremia during admission remained an independent predictor of postdischarge death (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.3-3.2; P = .002). Hyponatremia during admission was also independently associated with postdischarge readmission for heart failure (HR, 1.6; 95% CI, 1.1-2.6; P = .04). When serum sodium level was used as a continuous variable, the adjusted HR for death or heart failure was 1.12 for every 1-mEq/L decrease (95% CI, 1.07-1.18; P<.001).

Conclusion  Hyponatremia in the early phase of ST-elevation myocardial infarction is a predictor of long-term mortality and admission for heart failure after hospital discharge, independent of other clinical predictors of adverse outcome and left ventricular ejection fraction.

Author Affiliations: Departments of Cardiology, Rambam Medical Center and Rappaport Medical School, Haifa, Israel.

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