Author + information
- Miklos Rohla,
- Matthias Freynhofer,
- Ioannis Tentzeris,
- Rudolf Jarai,
- Serdar Farhan,
- Johann Wojta,
- Kurt Huber and
- Thomas Weiss
The utilization of plasma osmolality as unspecific marker for endogenous stress, predicting clinical outcome in the context of acute coronary syndrome (ACS), has not been investigated so far.
In a retrospective analysis we included 985 consecutive patients with ACS, who were referred for percutaneous coronary intervention (PCI) + stenting. Plasma osmolality was calculated using concentrations of sodium, plasma glucose and blood urea nitrogen at admission. In addition, peak levels of creatine kinase-myocardial band isoenzyme fraction (CK-MB) were measured. As primary endpoint, in-hospital mortality from all causes was evaluated for each quartile of osmolality and compared between groups. As secondary endpoint, myocardial injury was evaluated comparing peak levels of CK-MB between groups.
Median osmolality was 283 mosmol/kg (IQR 279;287), rates of in-hospital death were 9 (3.7 %), 9 (3.7%), 6 (2.4 %) and 41 (16.6 %) for Quartile (Q)1 to Q4, respectively. Since similar rates of death for Q1-Q3 were observed (p=0.8), those groups were combined for further analysis. Univariate analysis in the cox proportional-hazards model revealed significantly higher rates of in-hospital death for patients in Q4, as compared to Q1-Q3 (HR 5.4, 95% CI 3.3;9.0, p<0.01). After adjustment for confounding baseline variables (age, renal failure, diabetes, peripheral vascular disease, smoking, heart failure and history for malignancies) osmolality in Q4 was associated with 3.7-fold hazard of in-hospital death (HR 3.7, 95% CI 1.9;7.0, p<0.01). Moreover, peak levels of CK-MB were significantly higher in Q4, as opposed to Q1-Q3 (median 150.0 U/l vs. 187.5 U/l, p=0.02).
Using the 4th quartile of plasma osmolality at admission as a natural cut-off point, osmolality in Q4, as compared to Q1-Q3, was highly predictive of in-hospital outcome in ACS patients undergoing coronary stenting. Our data suggests osmolality to be a feasible and cost-effective marker for predicting in-hospital death in ACS patients. Keeping in mind all limitations of a retrospective analysis, further investigations are needed to confirm these results and to determine underlying mechanisms.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: The Blood Tells a Story: Coeptin, Fatty Acid Binding Protein, NT-Pro BNP and More
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1259-212
- 2013 American College of Cardiology Foundation