Objective: To determine whether low serum cortisol concentrations are associated with adverse prognosis in patients with acute myocardial infarction. Low serum cortisol concentrations have been associated with adverse prognosis in critical illness of diverse etiology.
Design: Nested case-control study.
Setting: Prospective cohort study of consecutive patients admitted with acute myocardial infarction to nine Scottish hospitals.
Patients: A total of 100 patients who survived 30 days (controls) and 100 patients who died within 30 days (cases).
Measurements and main results: Admission cortisol concentrations were lower in patients who died than those who survived (median, 1189 nmol/L vs. 1355 nmol/L; p < .001). A cortisol concentration in the bottom quartile (<1136 nmol/L) was a strong predictor of death within 30 days and remained so after adjustment for age and cardiac troponin concentration (adjusted odds ratio, 8.78; 95% confidence interval, 3.09-24.96; p < .001).
Conclusions: Patients who mount a lesser cortisol stress response to acute myocardial infarction have a poorer early prognosis.