To assess the association between plasma levels of aldosterone on admission for acute coronary syndrome, mental status and outcome in elderly (≥75) patients.

After exclusion of patients with unstable conditions, neurological disorders or language deficiency, we assessed MSA defined by an abnormal confusion assessment test or Mini Mental Status Evaluation (MMSE<27) in 138 consecutive patients≥75 years old. Plasma aldosterone levels were measured on samples drawn on admission. 3-month follow-up was completed in all patients.

MSA identified in 78(58%) patients. Medical and interventional management was similar between patients with and without MSA. At 3 months follow-up 14 (10.5%) patients were reported dead (15.4% with MSA 3.6% without MSA). MSA was also associated with high aldosterone levels (p=0.009). On univariate Cox analysis mortality was associated with higher levels of plasma aldosterone (p=0.002), MSA (p=0.03), mmSE (0.004) and GRACE score (p=0.02) but not age, neither gender. On multivariate analysis, aldosterone levels (adjHR 1.8[1.05;2.99] per log-aldosterone) andmmSE (adjHR 0.85[0.75;0.98] per point) but not GRACE score were predictive of mortality.

MSA is detected in a majority of patients≥75 years old presenting with ACS using simple clinical tests. Despite similar management short term mortality is higher in such patients. Aldosterone levels on admission are predictive of both MSA and mortality, but the association between MSA and mortality seems independent of aldosterone levels. Our results support further studies to assess the impact of aldosterone antagonists in the setting of ACS in elderly to improve both mortality and MSA.