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Outcomes associated to serum phosphate levels in patients with suspected acute coronary syndrome
Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Baxter Novum, Stockholm, Sweden..
Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Baxter Novum, Stockholm, Sweden..
Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Baxter Novum, Stockholm, Sweden..
Karolinska Univ Hosp Stockholm, Dept Med Huddinge, Stockholm, Sweden.;Karolinska Inst, Karolinska Univ Hosp Stockholm, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Karolinska Univ Hosp Stockholm, Dept Cardiol, Stockholm, Sweden..
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2017 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 245, p. 20-26Article in journal (Refereed) Published
Abstract [en]

Background:

We investigated the association between phosphate and the risk of adverse clinical outcomes in patients with manifest cardiovascular disease (CVD).

Methods:

Observational study of patients hospitalized during 2006-2011 in Stockholm, Sweden, because of suspected acute coronary syndrome (ACS). The exposure was serum phosphate during the hospitalization. We modeled the association between phosphate and in-hospital death or in-hospital events (composite of myocardial infarction, cardiogenic shock, resuscitated cardiac arrest, atrial fibrillation, or atrioventricular block) as well as the one-year post-discharge risk of death or cardiovascular event (composite of myocardial re-infarction, heart failure and stroke). Confounders included demographics, comorbidities, kidney function, diagnoses, in-hospital procedures and therapies.

Results:

Included were 2547 patients (68% men, mean age 67 +/- 14 years) with median phosphate of 1.10 (range 0.14-4.20) mmol/L. During hospitalization, 198 patients died and 328 suffered an adverse event. Within one year post-discharge, further 381 deaths and 632 CVD events occurred. The associations of phosphate with mortality and CVD were J-shaped, with highest risk magnitudes at higher phosphate levels. For instance, compared to patients in the 50th percentile of phosphate distribution, those above the 75th percentile (1.3 mmol/L, normal range) had significantly higher odds for in-hospital death [odds ratio 1.36, 95% confidence interval (CI) (1.08-1.71)] and of CVD post-discharge [sub-hazard ratios 1.17 (1.03-1.33)].

Conclusions:

In patients with suspected ACS, both higher and lower phosphate levels associated with increased risk of adverse outcomes during the index hospitalization and within one year post-discharge. The risk association was present already within normal-range serum phosphate values.

Place, publisher, year, edition, pages
2017. Vol. 245, p. 20-26
Keywords [en]
Acute coronary syndrome, Chronic kidney disease, Phosphate, Death, in hospital, Post-discharge
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-336288DOI: 10.1016/j.ijcard.2017.07.050ISI: 000411288700004PubMedID: 28734575OAI: oai:DiVA.org:uu-336288DiVA, id: diva2:1177322
Available from: 2018-01-25 Created: 2018-01-25 Last updated: 2018-01-25Bibliographically approved

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Ärnlöv, Johan

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