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[8] Kawano Y, Tsuchihashi T, Matsuura H, Ando K, Fujita T, Ueshima H. Working group for dietary salt reduction of the Japanese Society of Hypertension. Report of the Working Group for Dietary Salt Reduction of the Japanese Society of Hypertension: (2) assessment of salt intake in the management of hypertension. Hypertens Res 2007;10:887–93. [9] Damgaard M, Goetze JP, Norsk P, Gadsboll N. Altered sodium intake affects plasma concentrations of BNP but not proBNP in healthy individuals and patients with compensated heart failure. Eur Heart J 2007;28:2726–31. 0167-5273/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2012.09.201 Impact of a recent hospitalization on treatment and prognosis of ST-segment elevation myocardial infarction Gianluca Campo a,b, ⁎, Nicola Napoli c , Carlotta Serenelli d , Matteo Tebaldi a,b , Roberto Ferrari a,b,e a Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy b LTTA Center, Ferrara, Italy c Programmazione e controllo di gestione, Statistica Sanitaria, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy d Dipartimento Cure Primarie, Azienda Sanitaria Locale di Ferrara, Ferrara, Italy e Cardiovascular Research Centre, Salvatore Maugeri Foundation, IRCCS, Lumezzane (BS), Italy article info Article history: Received 20 September 2012 Accepted 26 September 2012 Available online 22 October 2012 Keywords: Hospitalization Myocardial infarction Primary percutaneous coronary intervention Survival Surgery Clinical outcome To the Editor: It is known that the hospital readmissions for non-cardiac surgery and for bleedings after myocardial infarction (MI) were common and negatively influenced mortality [1–3]. On the contrary, the relationship between a hospitalization in the months immediately prior and an ST- segment elevation myocardial infarction (STEMI) has been less investigated. Then, we performed this analysis to determine the frequency and causes with which the hospitalizations occurred in the 6 months before STEMI and the influence on prognosis. We considered all STEMI patients (from January 2005 to December 2010) undergoing primary percutaneous coronary intervention (PCI) in our cath-lab. Two groups were identified based on whether the patients were admitted to the hospital six months prior to STEMI. We excluded 8 STEMI patients whose MI resulted in complication during hospitalization for other causes. An independent reviewer (CS) controlled all the data regarding these hospital admissions. At 1-year follow-up, we recorded the following: death, MI, coronary revascularization (CR), acute/ congestive heart failure (HF) and serious bleeding (SB) [1,3]. Informed written consent was obtained from all patients, and the study was approved by the local ethics review board. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology. Continuous variables were expressed as mean ± SD and compared with the Student's unpaired t test. Categorical variables were expressed as counts and percentages, and the χ 2 test was applied. The prognostic value of the variables in Table 1 was examined using a Cox-proportional hazards model. Multivariable analysis was performed to identify the independent predictors for death. A p-value b 0.05 was significant. All analyses were performed with Statistica 8 (Statsoft Inc., Tulsa, Oklahoma). The study population included 1327 patients. Overall, 92 (7%) patients were hospitalized during the 6 months before the STEMI. Three of them had two hospitalizations. In 29 (31%) cases the cause was cardiac (14 for acute coronary syndrome, 9 for HF, 3 for arrhythmia, 3 for a CR procedure). In 66 (72%) cases the cause was not cardiac. The majority of cases (n=43, 65%) were for surgery (n=12 cancer, n=10 orthopedic, n=7 urologic, n =8 abdominal, n =6 vascular). Gastro-intestinal bleeding was the cause in 7 (11%) cases. Sixteen (24%) patients were hospitalized for other causes (Table 1). Patients with hospitalization before STEMI were elderly and with more previous cardiovascular events as compared to others (Table 1). Patients with recent hospitalization had less probability to receive glycoprotein IIb/IIIa inhibitors and radial artery as site of access for the procedure (Table 1). Also stent implantation was less common (89% vs. 95%, p b 0.01), and drug eluting stents were rarely used. With the exception of dual antiplatelet therapy (DAT), we did not observe any significant difference in the prescription of cardiovascular drugs. At 1-year, we observed 142 deaths (11%). After a multivariable analysis, the presence of a recent hospital admission emerged as an independent mortality predictor (HR 1.15, 95% CI 1.1–1.2, p b 0.01). Also all other adverse events were significantly more frequent in the group of patients with a recent hospital admission (Table 1). Interestingly, adverse events tended to be different between the patients with a cardiac cause of hospitalization and those with a non-cardiac cause. The first group showed a higher risk of HF and CR, whereas the second group of SB (Table 1). Our first main finding is that the patients admitted for STEMI after a recent hospitalization are a very high risk subgroup with a poor ⁎ Corresponding author at: Cardiovascular Institute, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44124, Cona, (FE), Italy. Tel.: + 39 0 532 202143; fax: + 39 0 532 241885. E-mail address: cmpglc@unife.it (G. Campo). 296 Letters to the Editor