Serum calcium levels independently predict in-hospital mortality in patients with acute myocardial infarction A. Shiyovich a, *, Y. Plakht b , H. Gilutz b a Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, and “Sackler” Faculty of Medicine, Tel-Aviv University, Israel b Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel Received 27 November 2017; received in revised form 14 January 2018; accepted 22 January 2018 Handling Editor: Peter Clifton Available online --- KEYWORDS Serum calcium levels; Acute myocardial infarction; In-hospital mortality Abstract Background and aim: Serum calcium levels (sCa) were reported to be associated with cardiovascular risk factors, incidence of coronary artery disease and acute myocardial infarction (AMI). The current study evaluated the association between sCa and in-hospital mortality among AMI patients. Methods and results: Patients admitted in a tertiary medical center for AMI throughout 2002 e2012 were analyzed. For each patient, mean sCa, corrected to albumin, was calculated and categorized to seven equally-sized groups: <8.9, 8.9e9.12, 9.12e9.3, 9.3e9.44, 9.44e9.62, 9.62e9.86, 9.86 mg/dL. The primary outcome was all-cause in-hospital mortality. 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 5.6e13.2 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 signi ficant 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 signi ficantly increased in-hospital mortality: OR Z 2.4 (95% CI:1.7 e3.3) and 1.7 (95%CI:1.2 e2.4), for Ca<8.9 and Ca9.86 mg/dL respectively p < 0.01, as compared with middle rage sCa group (9.3e9.44 mg/dL). Conclusion: sCa is an independent predictor of in-hospital mortality in patients with AMI with a U-shaped association. Both increased and decreased sCa levels are associated with increased risk of in-hospital mortality. ª 2018 Published by Elsevier B.V. on behalf of The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Introduction Risk stratification after acute myocardial infarction (AMI) is of great importance for prudent therapeutic decision- making. Calcium is the most abundant mineral in the human body [1]. While most of the body’s calcium is sequestered in the skeleton, the free, hydrated cation is a key physiologic mediator in a host of metabolic and reg- ulatory processes [1]; impacting cardiovascular disease: platelet adhesion, blood coagulation, cardiac contraction, cardiomyocyte apoptosis and electrophysiology [2,3]. Serum calcium levels (sCa) has been previously reported to be associated with cardiovascular risk factors such as hypertension, dyslipidemia, blood glucose abnormalities, * Corresponding author. Beilinson Hospital, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva, 49100, Israel. E-mail address: arthur.shiyovich@gmail.com (A. Shiyovich). Please cite this article in press as: Shiyovich A, et al., Serum calcium levels independently predict in-hospital mortality in patients with acute myocardial infarction, Nutrition, Metabolism & Cardiovascular Diseases (2018), https://doi.org/10.1016/j.numecd.2018.01.013 https://doi.org/10.1016/j.numecd.2018.01.013 0939-4753/ª 2018 Published by Elsevier B.V. on behalf of The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Nutrition, Metabolism & Cardiovascular Diseases (2018) xx,1e 7 Available online at www.sciencedirect.com Nutrition, Metabolism & Cardiovascular Diseases journal homepage: www.elsevier.com/locate/nmcd