Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 7:9:929634.
doi: 10.3389/fcvm.2022.929634. eCollection 2022.

Higher serum phosphorus and calcium levels provide prognostic value in patients with acute myocardial infarction

Wei Cao  1   2 , Yilan Li  1   3 , Yao Wen  1 , Shaohong Fang  1   3 , Bing Zhao  1   3 , Xiaoyuan Zhang  1   3 , Yanxiu Zhang  1   3 , Xueyan Lang  1   3 , Bo Yu  1   3 , Yao Zhang  1   3
Affiliations

Higher serum phosphorus and calcium levels provide prognostic value in patients with acute myocardial infarction

Wei Cao et al. Front Cardiovasc Med. .

Erratum in

Abstract

Background: Although traditional cardiovascular risk factors are closely related to the poor prognosis of acute myocardial infarction (AMI) patients, there are few studies on the relationship of serum phosphorus and calcium with prognosis in AMI patients. The relationship of serum phosphorus and calcium with prognostic biomarkers in AMI remains unclear.

Methods and results: A total of 3,891 AMI patients were enrolled from a prospective cohort study. We investigated the association of serum phosphorus and calcium with prognostic biomarkers. The risk of in-hospital heart failure (HF), post-discharge HF, all-cause mortality and cardiac mortality was estimated across quartiles of serum phosphorus and calcium levels. Serum phosphorus and calcium levels were associated with biomarkers of prognosis. Overall, 969 patients developed in-hospital HF during hospitalization, 549 patients developed post-discharge HF during a median follow-up of 12 months, and 252 patients died, with 170 cardiac deaths since admission. In the fully adjusted model, compared with patients in quartile 2 (Q2), patients with serum phosphorus levels in Q4 were at greater risk of post-discharge HF [sub-distributional hazard ratios (SHR) 1.55; 95% confidence interval (CI), 1.21-1.99], in-hospital HF [odds ratio (OR) 1.84; 95% CI, 1.47-2.31], all-cause mortality (HR 1.59; 95% CI, 1.08-2.32), and cardiac mortality (SHR 1.68; 95% CI, 1.03-2.75). Compared with patients in Q2, patients with corrected calcium levels in Q4 had a higher risk of in-hospital HF (OR 1.62; 95% CI, 1.29-2.04), all-cause mortality (HR 1.99; 95% CI, 1.37-2.88), and cardiac mortality (SHR 1.87; 95% CI, 1.19-2.96; all p-trend < 0.05).

Conclusion: Serum phosphorus and calcium levels were associated with AMI prognostic biomarkers in AMI. Higher serum phosphorus was independently related to the increased risk of in-hospital HF, postdischarge HF, all-cause mortality and cardiac mortality, and higher serum calcium was independently related to the increased risk of in-hospital HF, all-cause mortality and cardiac mortality after AMI.

Keywords: acute myocardial infarction; heart failure; mortality; prognosis; serum calcium; serum phosphate.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study sample. AMI, acute myocardial infarction; HF, heart failure.
Figure 2
Figure 2
Kaplan-Meier curves of the proportion of AMI patients free of clinical outcomes. Shown are the proportion of patients free of post-discharge HF (A), survival rate (B), and the proportion of patients free of cardiac death (C) for serum phosphorus, and the proportion of patients free of post-discharge HF (D), survival rate (E), and the proportion of patients free of cardiac death (F) for corrected serum calcium. AMI, acute myocardial infarction; HF, heart failure; Q, quartile.
Figure 3
Figure 3
Restricted cubic spline fitting for the association of serum phosphorus with the risk of in-hospital HF (A), post-discharge HF (B), all-cause mortality (C), and cardiac mortality (D), and the association of corrected serum calcium with the risk of in-hospital HF (E), post-discharge HF (F), all-cause mortality (G), and cardiac mortality (H). ORs or HRs were evaluated based on a univariate logistic regression or Cox proportional regression model. The area between dotted lines represents the 95% CI. CI, confidence interval; HF, heart failure; HR, hazard ratio; OR, odds ratio.
Figure 4
Figure 4
The risk regression analysis of clinical outcomes based on fully adjusted models. Shown are the cumulative incidence of post discharge HF treating death without HF as competing risk (A), the cumulative hazard of all-cause death (B), and the cumulative incidence of cardiac death treating non-cardiac death as competing risk (C) for serum phosphate, and the cumulative incidence of post-discharge HF treating death without HF as competing risk (D), the cumulative hazard of all-cause death (E), and the cumulative incidence of cardiac death treating non-cardiac death as competing risk (F) for corrected serum calcium. HF, heart failure; Q, quartile.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Minicucci MF, Azevedo PS, Polegato BF, Paiva SA, Zornoff LA. Heart failure after myocardial infarction: clinical implications and treatment. Clin Cardiol. (2011) 34:410–4. 10.1002/clc.20922 - DOI - PMC - PubMed
    1. Cleland JG, Torabi A, Khan NK. Epidemiology and management of heart failure and left ventricular systolic dysfunction in the aftermath of a myocardial infarction. Heart. (2005) 91(Suppl.2):ii7–1. 10.1136/hrt.2005.062026 - DOI - PMC - PubMed
    1. Gerber Y, Jaffe AS, Weston SA, Jiang R, Roger VL. Prognostic value of cardiac troponin T after myocardial infarction: a contemporary community experience. Mayo Clin Proc. (2012) 87:247–54. 10.1016/j.mayocp.2011.11.013 - DOI - PMC - PubMed
    1. Al Aseri ZA, Habib SS, Marzouk A. Predictive value of high sensitivity C-reactive protein on progression to heart failure occurring after the first myocardial infarction. Vasc Health Risk Manag. (2019) 15:221–7. 10.2147/VHRM.S198452 - DOI - PMC - PubMed
    1. Scirica BM, Cannon CP, Sabatine MS, Jarolim P, Sloane S, Rifai N, et al. . Concentrations of C-reactive protein and B-type natriuretic peptide 30 days after acute coronary syndromes independently predict hospitalization for heart failure and cardiovascular death. Clin Chem. (2009) 55:265–73. 10.1373/clinchem.2008.117192 - DOI - PubMed