Decreased and Increased Mortality in Patients with Acute Myocardial Infarction Serum Calcium Levels are Independent Predictors of In-Hospital

Background: Serum calcium levels (sCa) are associated with cardiovascular risk factors, incidence of coronary artery diseases (CAD), However data regarding outcomes in acute myocardial infarction (AMI) patients are scarce.
Objective: to evaluate the association between sCa and in-hospital mortality among AMI patients.
Methods: retrospective analysis of patients admitted in a tertiary medical center, for AMI. Exclusion criteria: chronic dialysis or missing sCa. For each patient, mean sCa, corrected to albumin, was calculated and categorized to seven equally-sized groups (figure). Primary outcome: all-cause in-hospital mortality.
Results: out of 12,121 AMI patients, 11,446 were included, mean age 67.1 ±14 years, 68% Males. Mean number of sCa values for patient was 4.2±7.3. Mean sCa was 9.4±0.53 mg/dL, range 5.6-13.2 mg/dL. sCa was significantly associated with cardiovascular risk-factors, in-hospital complications, more frequent 3-vessel coronary artery disease and decreased rate of revascularization, often in a U-shaped association. Overall 794 (6.9%) patients died in-hospital. Multivariate analysis showed a significant U-shaped association between sCa and in-hospital mortality with sCa below 9.12 mg/dL and above 9.86 mg/dL as independent predictors of significantly increased in-hospital mortality (OR=2.4 [95% CI:1.7-3.3] and 1.7 [95%CI:1.2-2.4], for Ca
Conclusion: Increased and decreased sCa are independent predictors of in-hospital mortality of patients with AMI.