Altered serum calcium homeostasis independently predicts mortality in patients with acute coronary syndrome: a retrospective observational cohort study

Abstract

Objectives: Serum calcium levels (sCa) were reported to be associated with risk of cardiovascular diseases. The aim of this study was to analyse the association between sCa and long-term mortality in patients with acute coronary syndrome (ACS).

Design: A retrospective observational cohort study.

Setting: Single-centre study with participants recruited from the local area.

Participants: A total of consecutive 13 772 patients with ACS were included in this analysis. Patients were divided based on their sCa profile (≤2.1 mmol/L, 2.1-2.2 mmol/L, 2.2-2.3 mmol/L, 2.3-2.4 mmol/L, 2.4-2.5 mmol/L,>2.5 mmol/L) and followed up for a median of 2.96 years (IQR 1.01-4.07).

Primary outcome: Long-term all-cause mortality.

Results: During a median follow-up period of 2.96 years, patients with sCa ≤2.1 mmol/L had the highest cumulative incidences of all-cause mortality (16.7%), whereas those with sCa 2.4-2.5 mmol/L had the lowest cumulative incidences of all-cause mortality (3.5%). After adjusting for potentially confounding variables, the Cox analysis revealed that compared with the reference group (sCa 2.4-2.5 mmol/L), all the other groups had higher mortality except for the sCa 2.3-2.4 mmol/L group (HR, 1.32, 95% CI 0.93 to 1.87). Restricted cubic splines showed that the relationship between sCa and all-cause mortality seemed to be U shaped. The optimal sCa cut-off point, 2.35 mmol/L, was determined based on the shape of restricted cubic splines.

Conclusions: Altered serum calcium homeostasis at admission independently predicts all-cause mortality in patients with ACS. In addition, a U-shaped relationship between sCa and all-cause mortality exists, and maintaining sCa at approximately 2.35 mmol/L may minimise the risk of mortality.

Keywords: coronary heart disease; ischaemic heart disease; myocardial infarction.

Figure 1

Study population and selection. ACS, acute coronary syndrome.

Figure 2

Kaplan-Meier curves indicating the all-cause mortality in different serum calcium categories among patients with acute coronary syndrome.

Figure 3

Multivariate Cox proportional hazards models for prediction of all-cause mortality among patients with acute coronary syndrome. AMI, acute myocardial infarction; BMI, body mass index; CABG, coronary artery bypass grafting; EF, ejection fraction; eGFR, estimated glomerular filtration rate; HbAlc, glycosylated haemoglobin; LDL-C, low density lipoprotein cholesterol; PCI, percutaneous coronary intervention; UAP, unstable angina pectoris.

Figure 4

Association between serum calcium levels and all-cause mortality using restricted cubic splines.