Abstract
Serum calcium has been reported to be a predictor of short-term prognosis; however, evidence regarding its association with midterm mortality is scarce. We investigated the association between serum calcium levels at admission and midterm mortality in a retrospective cohort of 2594 consecutive patients with acute coronary syndrome (ACS) who presented to the First Affiliated Hospital of Harbin Medical University from November 2014 to December 2016. Patients were assigned to 4 groups according to the quartiles of serum calcium levels (Ca-Q1–4) and were followed longitudinally for the time to all-cause death. During a median follow-up period of 21.8 months (17.5∼29.5, IQR), 124 patients died (4.8%) of all causes. Kaplan–Meier curves showed that the incidence of midterm mortality differed significantly (log-rank P=0.038) among the quartiles of serum calcium levels at admission. After adjustment for the confounders that were significant in the univariate analysis, the hazard ratios for the lowest quartile of serum calcium was 1.86 (95% CI, 1.05–3.31; P=0.033), compared with the third quartile (reference group). A multiple restricted cubic spline regression model suggested a reverse J-shaped association between serum calcium levels and midterm mortality, and the lowest risk of mortality was associated with approximately 2.32 mmol/l of serum calcium. In conclusion, the serum calcium level is an independent predictor of all-cause midterm mortality among ACS patients. Patients with abnormal serum calcium levels at admission need more targeted treatments.
Highlights
Acute coronary syndrome (ACS) continues to be the leading cause of morbidity and mortality worldwide, costing billions of dollars in medical costs and depleting many public health resources [1]
BioMed Research International mortality in acute coronary syndrome (ACS) patients is still scarce. erefore, whether the serum calcium level is an independent risk factor for midterm mortality or just an intermediate variable that is associated with other cardiovascular risk factors and clinical outcomes remains unknown
We investigated the possible association between serum calcium levels and midterm mortality in a large cohort of ACS patients in China
Summary
Acute coronary syndrome (ACS) continues to be the leading cause of morbidity and mortality worldwide, costing billions of dollars in medical costs and depleting many public health resources [1]. Several previous studies have shown that a decreased or/and increased serum calcium level is an independent risk factor for in-hospital mortality in patients with acute myocardial infarction [6,7,8,9,10]. The clinical outcomes of these studies were mainly in-hospital death or 30-day postdischarge death, and evidence regarding the association between serum calcium levels and midterm. Erefore, whether the serum calcium level is an independent risk factor for midterm mortality or just an intermediate variable that is associated with other cardiovascular risk factors and clinical outcomes remains unknown.
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