Study of hyponatremia as prognostic factor in acute ST elevation myocardial infarction (Stemi): A study in national institute of cardiovascular diseases and hospital, Dhaka, Bangladesh

Hyponatremia has been shown to be a predictor of cardiovascular mortality among patients with heart failure and the same mechanism of neurohormonal activation is also acting in cases of STEMI 1 Hence we aimed to investigate importance of hyponatremia in acute STEMI regarding prognosis and short term survival. 100 consecutive patients presenting with acute STEMI admitted to Rajendra institute of medical science (RIMS) Ranchi, Jharkhand from October 2016 to September 2017 were studied. Qualifying patients underwent detailed history and clinical examination. Plasma sodium concentrations were obtained on admission and at 24, 48 and 72 hours thereafter along with other relevant investigations. Males made up 81% of patients who presented with hyponatremia on admission and 77% of patients who developed hyponatremia within 72 hours. Patients who presented with or developed hyponatremia more often were smokers(81%) and had diabetes(44%), anterior infarction(72%) and higher killip class, lower ejection fraction(40.36 ±6.14) compared to patients with normal sodium levels. The odd’s ratio for 30-day mortality was found to be high in the hyponatremic groups compared to normal group. We also found a significant linear relationship between severity of hyponatremia and mortality. Multivariate analysis was performed which identified hyponatremia on admission or early development of hyponatremia as a significant independent predictor of 30 day mortality.