Background

Acute coronary syndrome is a frequent cause of morbidity and mortality, and a known stress response trigger. We aim to investigate the association between cortisol, as a primary stress hormone, and prognosis/mortality in this scenario.

Methods

Single-center, prospective, observational and analytical study in patients admitted for acute coronary syndrome. Clinical characteristics and prognosis markers were registered, along with serum cortisol levels on admission and in-hospital mortality.

Results

Cortisol levels were higher in patients with a depressed ST segment (18.22 ± 13.38 μg/dL), compared to those with an isoelectric ST segment (12.66 ± 10.47 μg/dL), and highest in patients with an elevated ST segment (22.61 ± 14.45 μg/dL), with p < 0.001. Also, cortisol was significantly increased in patients with elevated troponin I values (18.90 ± 14.19 μg/dL vs. 11.87 ± 8.21 μg/dL, p < 0.001). Patients with Killip-Kimball class I or II had a lower mean serum cortisol (14.66 ± 10.82 μg/dL) than those with class III or IV (41.34 ± 15.57 μg/dL), p < 0.001. Finally, we found that patients who died during hospitalization had higher cortisol on admission: 36.39 ± 17.85 μg/dL vs. 15.26 ± 11.59 μg/dL, p = 0.003.

Conclusion

Cortisol was directly related to the electrocardiographic presentation of ACS and with the maximum troponin I value. This indicates that serum cortisol levels parallel the extension of ischemia and myocardial injury, and in this way affect the clinical prognosis, evidenced by the Killip-Kimball class and the increase in mortality.

中文翻译：

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皮质醇介导的急性冠脉综合征的应激反应和死亡率。

背景

急性冠状动脉综合征是发病和死亡的常见原因，并且是已知的应激反应触发因素。我们的目的是调查这种情况下作为主要应激激素的皮质醇与预后/死亡率之间的关系。

方法

对急性冠脉综合征住院患者进行的单中心，前瞻性，观察性和分析性研究。记录临床特征和预后指标，以及入院时的血清皮质醇水平和住院死亡率。

结果

ST段压低的患者（18.22±13.38μg/ dL）的皮质醇水平高于等电ST段压的患者（12.66±10.47μg/ dL），而ST段升高的患者的皮质醇水平最高（22.61±14.45） μg/ dL），p <0.001。此外，肌钙蛋白I值升高的患者中皮质醇显着增加（18.90±14.19μg/ dL vs. 11.87±8.21μg/ dL，p <0.001）。Killip-Kimball I级或II级患者的平均血清皮质醇（14.66±10.82μg/ dL）低于III级或IV级（41.34±15.57μg/ dL），p <0.001。最后，我们发现住院期间死亡的患者入院时皮质醇水平更高：36.39±17.85μg/ dL与15.26±11.59μg/ dL，p = 0.003。

结论

皮质醇与ACS的心电图表现直接相关，并与最大肌钙蛋白I值相关。这表明血清皮质醇水平平行于局部缺血和心肌损伤，并以这种方式影响临床预后，这由Killip-Kimball类和死亡率增加所证明。