Abstract 3134: Aldosterone A Major Determinant Of Long Term Mortality in Elective PCI
Background: Aldosterone, the final mediator of the renin-angiotensin-aldosterone pathway, exerts toxic effects on the vessel wall and the myocardium. We recently demonstrated that aldosterone levels predict long term mortality in patients treated by primary PCI for an acute myocardial infarction. Whether aldosterone levels predict long term clinical outcome in elective PCI remains currently unknown.
Methods and Results: In 807 consecutive patients undergoing elective PCI, plasma aldosterone, hsCRP and troponin levels were measured before the procedure. During follow-up (median = 14.9 months), 52 patients died including 40 from a cardiovascular cause. Plasma aldosterone levels (median = 25 pg/mL, interquartile range = 13– 45 pg/mL) were higher in diabetics (p=0.01) or in patients with a higher NYHA class (p=0.0002), and were inversely related to age (p=0.0001). In univariate analysis, a plasma aldosterone > 25 pg/mL was associated with a higher mortality (9.0% vs 3.7%, p=0.01) and a higher cardiovascular mortality rate (8.2% vs 2.5%, p=0.0005, Figure⇓). Using a multivariable Cox model analysis, 6 variables were associated with cardiovascular mortality: plasma aldosterone [HR (log) = 3.48; p=0.004], hsCRP [HR (log) = 2.59; p=0.002], recent acute coronary syndrome [HR = 3.23, p=0.02], age [HR for a 10 year-increase = 1.42; p=0.04], diabetes [HR = 2.20; p=0.04] and LVEF [HR for a 10%-decrease = 1.58; p=0.001].
Conclusion: A high plasma level of aldosterone in patients referred for an elective PCI is an independent predictor of cardiovascular mortality during follow-up. Whether such patients could benefit from aldosterone antagonist remains to be tested.