Relationship between admission serum sodium levels and mortality in patients with cardiogenic shock complicated by acute myocardial infarction

Relationship between admission serum sodium levels and mortality in patients with cardiogenic shock complicated by acute myocardial infarction | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relationship between admission serum sodium levels and mortality in patients with cardiogenic shock complicated by acute myocardial infarction Qian-feng Xiao, Fang-yang Huang, Si Wang, Yan Yang, Ying Xu, Mao Chen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6812459/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background Serum sodium plays an important role in hospitalized patients, but the impact of serum sodium levels on mortality in cardiogenic shock followed by acute myocardial infarction (AMI-CS) patients has not been evaluated. This study was designed to assess the serum sodium levels on mortality in patients with AMI-CS. Methods We enrolled and completed the follow-up of 312 patients with AMI-CS. The primary endpoint was all-cause mortality. Patients were divided into three groups by tertiles based on admission serum sodium levels. The prognostic value of admission serum sodium levels was evaluated using Kaplan–Meier survival curves and Cox regression, and the linearity assumption for admission serum sodium levels and mortality was evaluated. Subgroup analyses were also performed. Results Compared to individuals exhibiting sodium levels ranging from 138.0 to 141.2 mmol/L, patients with sodium levels > 141.2 mmol/L demonstrated comparable long-term mortality rates but a heightened short-term mortality risk. Additionally, a J-shaped association was observed between admission serum sodium levels and mortality. The subgroup analysis suggested that sex, diabetes, and utilization of mechanical circulatory support exert influenced the association between admission serum sodium levels and mortality in AMI-CS patients. Conclusions Elevated admission serum sodium levels were identified as an independent predictor of mortality, particularly within the initial 30-day, among AMI-CS patients. The findings underscore the crucial clinical significance of effectively managing serum sodium levels in AMI-CS patients. Trial registration ChiCTR2500099275 (2025-3-20). Cardiogenic shock serum sodium level hypernatremia mortality Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Sodium holds a pivotal position within the human body, serving as the principal extracellular cation and playing a fundamental role in modulating cell volume. The normal reference range for serum sodium level generally lies between 135.0 mmol/L and 145.0 mmol/L 1–2 . Both hyponatremia and hypernatremia pose detrimental effects. Research has demonstrated that sodium imbalance represents a prevalent problem among hospitalized patients, with approximately 30–40% being affected. In the context of critically ill patients, the serum sodium level can potentially serve as an indicator of the disease state 3 – 4 . Roughly 20% of such patients encounter hyponatremia, which impacts 35% of hospitalized patients and 11.2% of those in the intensive care unit (ICU) 2 , 5 . Hypernatremia, albeit less common, occurs at a rate of 2–6% in ICU patients 6 . It has been established that hypernatremia serves as an independent risk factor for augmented in-hospital and short-term mortality in non-cardiovascular critically ill patients in the ICU 2 , 3 , 6 . Analogously, hyponatremia has been linked to cardiovascular events and mortality in patients afflicted with heart failure 7 – 10 . Cardiogenic shock (CS) is a primary cardiac disorder leading to hypotension and signs of organ hypoperfusion, occurring in the setting of normovolaemia or hypervolaemia. Epidemiological data regarding CS indicates that approximately 60–80% of the cases are attributed to acute myocardial infarction (AMI). The thirty-day mortality rate among CS patients caused by AMI is around 40%, and the 1-year mortality rate nears 50% 11–12 . Consequently, the identification of prognostic markers capable of guiding risk stratification and enhancing outcomes persists as a significant clinical conundrum for patients with cardiogenic shock following acute myocardial infarction (AMI -CS). Notably, there is a paucity of knowledge concerning the incidence and prognostic significance of dysnatremia in critically ill patients with AMI-CS admitted to the cardiac care unit (CCU). In the study, our objective is to investigate the correlation between admission serum sodium concentration and mortality rates among AMI-CS patients. Methods Study population and definitions This single-center retrospective cohort study was conducted from September 2018 to July 2023.The study included patients diagnosed with AMI-CS who received medical treatment at the West China Hospital of Sichuan University, renowned as the largest tertiary care hospital in the western region of China (Fig. 1 ). Patients met the following inclusion criteria: (a) AMI was diagnosed per the third universal definition of myocardial infarction 13 : acute myocardial injury with clinical evidence of acute myocardial ischemia (myocardial ischemic symptoms, new ischemic ECG changes, pathological Q waves, imaging evidence of new viable myocardium loss or regional wall motion abnormality consistent with ischemic etiology, or coronary thrombus identified by angiography/autopsy), and cardiac troponin elevation with at least one value > 99th percentile upper reference limit. (b) cardiogenic shock: a primary cardiac disorder leading to hypotension (systolic blood pressure 2 mmol/L, oliguria, altered mental status, cold and clammy skin/extremities) in the state of normovolaemia or hypervolaemia 11 . (c) cardiogenic shock stages B to E per the Society for Cardiovascular Angiography and Interventions (SCAI) criteria 11 . The exclusion criteria were as follows: (a) cardiopulmonary resuscitation (CPR) time of > 30 minutes due to pre-admission cardiac arrest (b) CS due to mechanical complications post-AMI, (c) CS due to ventricular tachycardia storm,(d) shock from other etiologies (e.g., septic/hemorrhagic shock), and (e) age > 90 years. Baseline data collection Demographic details, vital signs and medical history, along with information regarding mechanically supported therapies (such as mechanical circulatory and ventilation data), and the specific AMI type was from the hospital records. Laboratory parameters, with the admission serum sodium levels, were routinely assessed within 24 hours of admission, and baseline blood gas analysis and biochemical test results were obtained. The coronary angiography procedures data were sourced from corresponding images. Cardiac function including left ventricular ejection fraction(LVEF) was determined by echocardiography reports during admission. Cardiogenic shock scores(intra-aortic balloon pump in cardiogenic shock II, IABP SHOCK Ⅱ) were calculated according to the baseline data 14 . The IABPSHOCK Ⅱ scores were computed based on patients' baseline data at admission. These scores were evaluated with age, history of stroke, serum glucose, creatine, arterial lactate, and thrombolysis in myocardial infarction (TIMI) flow grade 3 achieved after percutaneous coronary intervention (PCI) 14 . Study endpoints The primary endpoint was all-cause death from hospital admission to follow-up. Secondary endpoints were the occurrence of sepsis, the need for dialysis and the incidence of brain injury. Follow-up information was obtained through telephone conversations, review of medical charts, and outpatient consultations. The integrity and accuracy of all data were verified and supported by the official hospital records, ensuring the reliability and validity of the information collected for the study. Ethics and patients’ consent The study was approved by the Ethics Committee of West China Hospital, Sichuan University (Chengdu, China; approval number: 2021–1770) and has been registered with the China Clinical Trials Registry(registration number:ChiCTR2500099275, date: 2025-3-20). Statistical analysis Patients were stratified into three groups based on admission serum sodium tertiles. The Kolmogorov–Smirnov test was employed to assess data distribution. Variables were presented as the means and medians, or frequencies and percentages, together with their corresponding ranges. The analysis of variance or the Kruskal–Wallis test was utilized across groups for continuous variables, and chi-squared or Fisher’s exact tests were applied to make comparisons of the qualitative variables among the groups. Survival rates were depicted in the form of Kaplan–Meier plots, and intergroup differences were analyzed with the log-rank test. Associations between variables and endpoints were first evaluated via univariate Cox regression. Variables showing significant mortality association (p < 0.10) in univariate tests were further analyzed using multivariate models. Additionally, the linearity assumption for the admission serum sodium levels and mortality was assessed. To investigate the potential heterogeneity in the impact of admission serum sodium levels on all-cause mortality, subgroup analyses were carried out. The subgroups comprised age categories (with a cut off 65 years), gender, out-of-hospital cardiac arrest (OHCA), stroke history, diabetes status, serum creatinine levels (with a cut off 132.6 µmol/L), ventilation status, and mechanical circulatory support. A two-sided P value < 0.05 was defined as statistically significant, while a P value < 0.1 was considered significant for interaction tests. All analyses were performed using Stata/MP 17.0, R package 4.1.0 and Prism 9. Results A sum of 312 AMI-CS patients were included(Fig. 1 ). The mean serum sodium level was 140.0 ± 5.0 mmol/L and the histogram depicted a broad dispersion of the admission sodium values. (Fig. 2 ). The incidences of hypernatremia and hyponatremia were 11.2% and 12.2% correspondingly. In accordance with the admission serum sodium level, the patients were stratified into three distinct groups using tertiles: those with Na 141.2 mmol/L. Baseline characteristics of each group are presented in Table 1 . The mean age of the patients was 67.6 years, with a total of 238 (76.0%) patients being male. Notably, there were no differences in age and sex distribution across groups. Upon admission, there were no discernible differences in systolic blood pressure (SBP), mean arterial pressure (MAP), or heart rate among patients. Moreover, no perceptible discrepancies were observed in the occurrence rates of comorbidities such as hypertension, Coronary artery disease(CAD), stroke, chronic kidney disease(CKD) and Peripheral Arterial Disease ( PAD), across the studied groups. However, the patients within the high serum sodium group exhibited a relatively elevated frequency of OHCA. The baseline lactate (3.85 mmol/L versus 4.10 mmol/L versus 6.77 mmol/L), serum creatinine (148.05 µmol/L versus 148.17 µmol/L versus 157.65 µmol/L), and troponin T (8662 ng/L versus 8274 ng/L versus 10000 ng/L) in the high serum sodium group were comparatively elevated in relation to those of the other two groups. Overall, 73.4% of the study patients were diagnosed with ST-segment elevation myocardial infarction (STEMI), among which 49.4% were specifically categorized as having anterior STEMI. Nevertheless, No significant statistical differences were detected across the groups. Furthermore, 76.0% of the patients required mechanical ventilation, and the group with serum sodium levels exceeding 141.2 mmol/L exhibited a relatively greater proportion of such cases. Moreover, 51.3% of the patients were provided with mechanical circulatory support, and the high serum sodium group demonstrated a higher prevalence of extracorporeal membrane oxygenation (ECMO) implantation. The ratios of patients who received coronary angiography, revascularization, coronary lesions and TIMI flow grade after PCI did not display any pronounced differences across the groups. In terms of the risk classifications of the IABPSHOCK II score, it was noted that the high serum sodium group manifested higher scores. Nevertheless, LVEF showed no significant intergroup differences. Table 1 Baseline and clinical characteristics of patients stratified by admission serum sodium levels of AMI-CS patients Admission serum sodium level, mmol/L Total(n = 312) 141.2(n = 104) P value Demographic data Age, years 67.6 ± 12.9 68.0 ± 12.5 65.2 ± 14.4 69.4 ± 11.4 0.059 Male(%) 238/312(76.0) 82/105(78.1) 80/103(77.7) 76/104(73.1) 0.641 BMI, kg/㎡ 23.5 ± 3.5 23.2 ± 3.7 23.8 ± 3.7 23.5 ± 3.0 0.064 SBP, mmHg 92.6 ± 15.1 92.8 ± 15.1 94.4 ± 16.2 90.6 ± 14.0 0.321 MAP, mmHg 72.0 ± 11.8 72.9 ± 12.0 72.9 ± 12.5 70.1 ± 10.6 0.229 Heart rate, bpm 97.7 ± 22.5 94.8 ± 20.1 100.6 ± 23.5 97.9 ± 23.5 0.185 OHCA(%) 61/312 10/105(9.5) 20/103(19.4) 31/104(29.8) 0.001 Cardiovascular risk factors/CVD Smoking(%) 150/312(48.1) 53/105(50.5) 52/103(50.5) 45/104(43.3) 0.486 Arterial hypertension(%) 149/312(47.8) 56/105(53.3) 41/103(39.8) 52/104(50) 0.127 Diabetes mellitus(%) 102/312(32.3) 44/105(41.9) 33/103(33.0) 24/104(23.1) 0.015 History of CAD(%) 61/312(19.6) 17/105(16.2) 20/103(19.4) 24/104(23.1) 0.455 History of Stroke(%) 26/312(8.3) 5/105(4.8) 7/103(6.8) 14/104(13.5) 0.059 Dyslipidemia(%) 51/312(16.7) 17/105(16.2) 21/103(20.4) 14/104(13.5) 0.404 Known of PAD(%) 8/312(2.6) 2/105(1.9) 3/103(2.9) 3/104(2.9) 0.871 CKD(%) 24/312(7.7) 8/105(7.6) 10/103(9.7) 6/108(5.8) 0.568 Laboratory results Serum sodium, mmol/L 140.0 ± 5.0 135.1 ± 2.5 139.7 ± 0.9 145.2 ± 4.0 0.000 Arterial lactate, mmol/l 4.91 ± 4.20 3.85 ± 3.59 4.10 ± 3.29 6.77 ± 4.92 0.000 Glucose, mmol/l 12.20 ± 6.28 12.56 ± 6.54 11.82 ± 6.44 12.20 ± 5.87 0.505 Serum creatinine, umol/l 149.29 ± 112.45 148.05 ± 117.19 148.17 ± 126.88 157.65 ± 76.43 0.000 TnT, ng/L 10000 8662 8274 10000 0.026 NT-proBNP, ng/L 9628 9343 8808 10738 0.518 STEMI(%) 229/312(73.4) 77/105(73.3) 70/103(68.0) 82/104(78.9) 0.208 Anterior STEMI(%) 154/312(49.4) 52/105(49.5) 47/103(45.6) 55/104(52.9) 0.580 Ventilation(%) 237/312(76.0) 71/105(67.6) 76/103(73.8) 90/104(86.5) 0.005 CAG(%) 284/312(91.0) 97/107(92.4) 92/103(89.3) 95/104(91.4) 0.735 Coronary lesions 0.219 Mono vessel disease(%) 79/283(27.9) 25/97(25.8) 27/92(29.3) 27/94(28.7) Bi vessel disease(%) 81/283(28.6) 34/97(35.0) 18/92(19.6) 29/94(30.9) Multi vessel disease(%) 123/283(43.5) 38/97(29.2) 47/92(51.1) 38/94(40.4) Revascularization(%) 259/312(83.0) 87/105(82.9) 83/103(80.6) 89/104(85.6) 0.632 Completely Revascularization(%) 128/312(41.0) 41/105(39.1) 40/103(38.8) 47/104(45.2) 0.571 TIMI flow grade = 3 after PCI(%) 238/283(84.1) 78/97(80.4) 81/92(88.0) 79/94(84.0) 0.424 Vasoactive drugs 304/312(97.4) 103/105(98.1) 98/103(95.2) 103/104(99.0) 0.181 IABP(%) 151/312(48.4) 45/105(42.9) 49/103(47.6) 57/104(54.8) 0.220 ECMO(%) 9/312(2.9) 2/105(1.9) 0/103(0) 7/104(6.7) 0.012 IABPSHOCK Ⅱ score 0.000 0–2(%) 194/312(62.1) 78/105(74.3) 73/103(70.9) 43/104(41.3) 3–4(%) 88/312(28.2) 18/105(17.1) 23/103(22.3) 47/104(45.2) 5–9(%) 30/312(9.7) 9/105 (8.6) 7/103(6.8) 14/104(13.5) LVEF,% 40.4 ± 11.3 39.5 ± 11.2 41.4 ± 10.2 40.3 ± 12.4 0.156 Abbreviations: AMI-CS = cardiogenic shock followed by acute myocardial infarction. AMI = acute myocardial infarction. CS = cardiogenic shock. BMI = body mass index. SBP = systolic blood pressure. MAP = mean arterial pressure. bpm = beats per minute. OHCA = out of hospital cardiac arrest. CVD = coronary vascular disease. CAD = coronary artery disease. PAD = Peripheral artery disease. CKD = chronic kidney disease. TnT = troponin T. STEMI = st-segment elevation myocardial infarction. CAG = Coronary angiography. TIMI = Thrombolysis in Myocardial Infarction. PCI = percutaneous coronary intervention. IABP = intra-aortic balloon pump. ECMO = Extracorporeal membrane oxygenation. IABPSHOCK = Intra-aortic balloon pump in Cardiogenic Shock. LVEF = left ventricular ejection fraction. The median follow-up duration was 291 days. A total of 162 individuals (51.9%) died, and among them, 133 cases (42.6%) occurred within the initial 30 days of the follow-up period. Additionally, 140 (44.9%) patients died due to cardiac-related causes (Table 2 ). The group with high serum sodium levels exhibited a greater all-cause mortality in comparison to the other two groups (62.5% vs. 44.7% vs. 48.6%, p = 0.026). The incidence rates of sepsis, dialysis, and brain injury in the hospital were 12.2%, 14.7%, and 4.2% correspondingly. Remarkably, the occurrence of sepsis, dialysis, and brain injury was more pronounced in the high serum sodium group, with respective rates of 15.4%, 18.3%, and 8.7% as opposed to the other groups. (Table 2 ). Table 2 The outcomes of the AMI- CS patients grouped by admission serum sodium levels . Admission serum sodium level, mmol/L Total(n = 312) 141.2(n = 104) P value Death(%) 162/312(51.9) 51/105(48.6) 46/103(44.7) 65/104(62.5) 0.026 Cardiac death(%) 140/312(44.9) 39/105(37.2) 45/103(43.7) 56/104(53.8) 0.009 Non-cardiac death(%) 22/312(7) 12/105(11.5) 1/103(1.0) 9/104(8.7) 0.01 Sepsis in hospital(%) 38/312(12.2) 12/103(11.4) 10/103(9.7) 16/104(15.4) 0.440 Dialysis in hospital(%) 46/312(14.7) 14/105(13.3) 13/103(12.6) 19/104(18.3) 0.458 Brain injury(%) 13/312(4.2) 1/105(0.9) 3/103(2.9) 9/104(8.7) 0.015 Abbreviation: AMI-CS = cardiogenic shock followed by acute myocardial infarction. The Kaplan–Meier survival curve (Fig. 3 ) revealed that, in contrast to the other groups, the group with serum sodium level exceeding 141.2 mmol/L exhibited significantly elevated mortality rate (p = 0.0088). After adjusting for variables such as age, SBP, heart rate, glucose, serum creatinine, TIMI flow grade post-PCI, and LVEF, admission sodium level, when regarded as a continuous variable, was found to be independently associated with mortality (HR = 1.04, 95%CI = 1.02–1.05, p = 0.025, Table 3 ). Subsequent Cox analyses demonstrated that an admission serum sodium level higher than 141.2 mmol/L could strongly predict mortality within 30 days(HR = 1.69, 95%CI = 1.11–2.56, p = 0.014, Fig. 4 ), yet it seemed not to have an impact long-term mortality. Moreover, we explored the potential curved association between sodium levels and mortality. Our results disclosed a J-shaped association between admission serum sodium concentrations and all-cause mortality in AMI-CS patients (Fig. 5 ). Table 3 Univariable and multivariable cox analyses in mortality of the AMI-CS patients. Univariable analysis Multivariable analysis HR(95%CI) p -Value HR(95%CI) p -Value Male 0.60(0.43–0.84) 0.003 Age, years 1.03(1.02–1.05) 0.000 1.04(1.02–1.05) 0.000 Serum sodium levels, mmol/L 1.06(1.03–1.10) 0.000 1.04(1.01–1.07) 0.025 SBP, mmHg 0.98(0.97–0.99) 0.000 0.98(0.96–0.99) 0.004 Heart rate, bpm 1.01(1.01–1.02) 0.000 1.01(1.00-1.02) 0.007 Ventilation 5.42(3.07–9.57) 0.000 3.08(1.57–6.05) 0.001 Arterial hypertension 1.71(1.25–2.33) 0.001 Diabetes 1.40(1.02–1.92) 0.04 CKD 1.73(1.03–2.90) 0.038 Glucose, mmol/L 1.05(1.03–1.07) 0.000 1.04(1.01–1.07) 0.005 Serum creatinine, umol/L 2.61(2.04–3.32) 0.000 1.82(1.27–2.62) 0.001 Revascularization 0.33(0.23–0.47) 0.000 TIMI flow grade = 3 after PCI 0.27(0.18–0.40) 0.000 0.29(0.18–0.47) 0.000 IABP 1.12(0.82–1.52) 0.475 ECMO 2.11(0.99–4.52) 0.054 LVEF, % 0.96(0.94–0.97) 0.000 0.98(0.96–0.99) 0.021 Abbreviations: AMI-CS = cardiogenic shock followed by acute myocardial infarction. AMI = acute myocardial infarction. CS = cardiogenic shock. HR = Hazard ratio. SBP = systolic blood pressure. CKD = chronic kidney disease. TIMI = Thrombolysis in Myocardial Infarction. PCI = percutaneous coronary intervention. IABP = intra-aortic balloon pump. ECMO = Extracorporeal membrane oxygenation. LVEF = left ventricular ejection fraction. The subgroup analysis revealed pronounced interactions between serum sodium levels and several factors in relation to mortality. Specially, there was a significant interaction with sex ( p for interaction = 0.07), previous diabetes mellitus (p for interaction = 0.04) and the utilization of mechanical circulatory support ( p for interaction = 0.018) for mortality. The connection between sodium levels and mortality was more prominent among male patients who were provided with mechanical circulatory support. In contrast, no such association could be detected among patients who had a prior history of diabetes mellitus (Fig. 6 ). Discussion Our research is dedicated to exploring the relationship between serum sodium concentration and mortality in AMI-CS patients. The findings of our study unearthed a remarkable association that elevated admission serum sodium levels correlate robustly with a high mortality rate, especially within the first 30 days. Patients with serum sodium levels exceeding 141.2 mmol/L were at a substantially higher risk of mortality. Moreover, the connection between admission serum sodium levels and all-cause mortality was especially prominent in male patients without diabetes and those who received mechanical circulatory support. These findings suggest hypernatremia as a crucial independent predictor of a poor short-term prognosis, emphasizing its significance in contrast to hyponatremia at the time of admission. Serum sodium concentration is of paramount importance in upholding the water and electrolyte balance within the human body. Dysnatremias, which are prevent electrolyte disturbances among hospitalized patients, typically originate from imbalances in the intake and loss of electrolyte-free water 4 . Maintaining an appropriate balance between water and serum sodium is crucial for the management of cardiovascular diseases as well as for intensive care patients. Roughly 20%-30% of heart failure (HF) patients exhibit dysnatremias upon admission, prompting the European Society of Cardiology heart failure guideline to recommend in-hospital monitoring of serum sodium level 7 , 15 . In previous reports, the rates of hyponatremia and hypernatremia were recorded as 16.37% and 8.16% respectively in a cohort of 4760 heart failure patients 6 , 7 . Nevertheless, no studies have explored serum sodium concentrations in CS patients, particularly those caused by AMI. Our study ascertained that 11.2% of AMI-CS patients suffered from hyponatremia, a prevalence comparable to that of HF patients. However, hypernatremia was more common, affecting 12.8% of AMI-CS patients. The underlying cause of hypernatremia in these patients has not yet to be elucidated. It is hypothesized that increased activity in the sympathetic nervous and renin-angiotensin aldosterone systems in AMI-CS patients leads to elevated levels of aldosterone and subsequent sodium retention. Renal insufficiency, which impairs the kidney’s capacity for urine dilution and concentration, may precipitate significant water loss and cause hypernatremia 6 . Additionally, critically ill patients, who frequently necessitate ventilation or circulatory support, encounter challenges in accessing water, thereby further heightening the susceptibility to hypernatremia. A recent study highlighted the association between trends in serum sodium levels and mortality in HF patients, demonstrating that both hyponatremia and hypernatremia are linked to elevated mortality rates 15 . In particular, hyponatremia served as a predictor for extended hospital stays, along with elevated in-hospital mortality and higher post-discharge early mortality rates among heart failure patients 8 – 9 . Moreover, another study revealed the connection between admission hyponatremia and in-hospital as well as 30-day mortality in AMI patients 10 . Dysnatremia is also regarded as a prevalent electrolyte abnormality of patients in the ICU that can precipitate poor prognosis 6 . Previous research confirmed that both hyponatremia and hypernatremia independently contribute to higher in-hospital and 28-day mortality rates among ICU patients 3 , 6 . Our study unveiled a J-shaped association between admission serum sodium levels and all-cause death in patients with AMI-CS, with elevated admission serum sodium levels being linked to an unfavorable prognosis, especially within initial 30 days. However, the underlying factors responsible for high serum sodium levels resulting in short-term mortality among CS patients remains ambiguous. Firstly, hypernatremia might exacerbate peripheral insulin resistance and hyperglycemia, thus impairing hepatic gluconeogenesis and lactate clearance, 16 , 17 evident from higher arterial lactate levels in our high serum sodium group. Secondly, hypernatremia can trigger neurological impairments, even after correction 9 , as substantiated by a higher occurrence of brain injuries, OHCA, and strokes prior to admission in our high serum sodium group and previous studies 2 , 3 , 18 . Thirdly, reports suggest that hypernatremia could undermine cardiac function, with research indicating a negative inotropic effect on myocardial contractility in both humans and animals 19 , 20 . Lastly, hypernatremia typically signifies water loss and hypovolemia, further aggravating the shock experienced by AMI-CS patients. The stratified analyses indicated that, in comparison to patients without mechanical circulatory support, the association between admission serum sodium levels and mortality was potentially more pronounced among those who had such support. This finding demonstrated that CS patients who had been implanted with IABP or ECMO were likely to have relatively unfavorable prognoses in the presence of hypernatremia. One potential explanation is that patients with IABP or ECMO devices are often bedridden, making them susceptible to infections and sepsis 21 , 22 , which are conditions associated with hypernatremia and poor outcomes. Intriguingly, our study revealed weaker relative mortality risk associations in AMI-CS patients with diabetes. The exact mechanism underlying this interaction association remained elusive. It is conceivable that the glucose levels in diabetic patients can induce osmotic dehydration, resulting in high serum sodium levels 3 . However, these high sodium levels might not precisely mirror the true severity of their underlying condition 16 . Moreover, hypernatremia is linked to insulin resistance, this effect could be mitigated in diabetes patients due to their pre-existing insulin resistance. our sex-stratified analyses showed that, in male patients, the predictive power of admission serum sodium concentrations for mortality was more pronounced. The cause of this difference remained uncertain; one potential factor could be the higher incidence of circulatory mechanical support utilization among male patients in our study. Nevertheless, we cannot exclude the possibility of significant bias due to the relatively small sample size of female patients. Our study could has the potential to establish appropriate serum sodium reference levels for AMI-CS patients, which could subsequently influence the clinical management of these patients. Based on the Kaplan–Meier survival curve and the J-shaped association between serum sodium concentrations and mortality in AMI-CS patients, we deduced that the optimal serum sodium range for this population lies between 138.0 and 141.2 mmol/L. This information could prove invaluable for clinicians in rapidly stratifying the risk of AMI-CS patients, as serum sodium levels are easily measurable and readily accessible. We also anticipate that it could play a significant role in guiding clinical decision-making regarding the selection of management strategies for these patients. Traditionally, the treatment approach for CS has centered on attempts to utilize diuretics to reduce volume load while concurrently restricting fluid intake 11 . However, for these patients with elevated serum sodium levels, caution must be exercised when considering the early use of loop diuretics, as this could exacerbate hypernatremia. Moreover, fluid intake should not be restricted in such cases. Additionally, the infusion of sodium-containing fluids in these CS patients ought to be limited. Some medications, like sodium glucose cotransporter 2(SLGT2) inhibitors such as dapagliflozin, might be beneficial for alleviating hypernatremia at an early stage in AMI-CS patients. This occurs because the initial osmotic and natriuretic diuresis triggered by SGLT2 inhibitors leads to an augmentation in vasopressin secretion and a decrease in free-water clearance 23 . For AMI-CS with hypernatremia, continuous renal replacement therapy might be a more aggressive option, as it can slowly, controllably, and continuously lower blood sodium 24 . Nevertheless, whether these approaches are effective requires further clinical practice and research. This study had several limitations. Firstly, This was a single center, observational study with a relatively small sample size, which might have rendered it underpowered to detect certain differences. Secondly, despite our attempts to adjust for multiple factors, it was challenging to completely eliminate confounding variables with this experimental approach. Thirdly, the conclusions of this study were confined to the potential predictive role of elevated baseline serum sodium levels for short-term outcomes. It is crucial to emphasize that this does not imply improving prognoses by correcting hypernatremia disorders. Similarly, although our study identified that patients with serum sodium levels of 138.0 to 141.2 mmol/L exhibited the lowest mortality, this observation should not be used to dictate the management of serum sodium concentrations during hospitalization or long-term follow-up. Therefore, prospective and multicenter studies ought to be conducted in the future to explore whether active correction of hypernatremia can improve the outcomes of AMI-CS patients. Conclusions The results of this study demonstrated a J-shaped association between admission serum sodium concentrations and all-cause mortality for AMI-CS patients. Notably, within the cohort, elevated admission serum sodium concentrations were linked to all-cause mortality, especially 30-day mortality. This may be helpful for risk stratification and clinical decision making regarding the selection of management strategies for AMI-CS patients. Future research should explore how early correction of sodium imbalances impacts the prognoses of AMI-CS patients. Abbreviations AMI Acute myocardial infarction AMI-CS Cardiogenic shock secondary to acute myocardial infarction BMI Body mass index CAD Coronary artery disease CCU Cardiac care unit CAD Coronary artery disease CPR Cardiopulmonary resuscitation CS Cardiogenic shock ECMO Extracorporeal membrane oxygenation HF Heart failure IABPSHOCK II Intra-aortic balloon pump in cardiogenic shock II ICU Intensive care unit LVEF Left ventricular ejection fraction MAP Mean arterial pressure OHCA Out-of-hospital cardiac arrest PCI Percutaneous coronary intervention PAD Peripheral artery disease SBP Systolic blood pressure SCAI Society for Cardiovascular Angiography and Interventions SLGT2 Sodium glucose cotransporter 2 STEMI ST-segment elevation myocardial infarction TIMI Thrombolysis in myocardial infarction Declarations Author Contributions Xiao Qianfeng: Conceptualization, Methodology, Software, Formal analysis, Writing- Original draft preparation. Huang Fangyang: Conceptualization, Methodology, Software, Writing- Reviewing and Funding acquisition. Wang Si: Formal analysis, Funding acquisition. Yang Yan: Data curation. Xu Ying: Project administration. Chen Mao: Supervision, Project administration. Wei Xin: Validation, Visualization, Investigation, Project administration, Writing- Reviewing and Editing. All authors have participated in the study as well as contributed to the drafting and approval of the final version of the manuscript. Funding This work was supported by Sichuan Science and Technology Program (Grant Numbers: 2023NSFSC0581 and 2023YFS0296). Data availability The data used and/or analyzed in this study are available from the corresponding author opon request. Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of West China Hospital, Sichuan University (Chengdu, China; approval number: 2021–1770). All participants gave written informed consent. Consent for publication Not applicable. Competing interests The authors declare there are no competing interests. References Sterns RH. Disorders of Plasma Sodium — Causes, Consequences, and Correction. N Engl J Med. 2015;372(1):55–65. Sakr Y, Rother S, Ferreira AM, et al. Fluctuations in Serum Sodium Level Are Associated With an Increased Risk of Death in Surgical ICU Patients. Crit Care Med. 2013;41(1):133–42. Qi Z, Lu J, Liu P, et al. Nomogram Prediction Model of Hypernatremia on Mortality in Critically Ill Patients. infect Drug Resist. 2023;16:143–53. Seay NW, Lehrich RW, Greenberg A. Diagnosis and Management of Disorders of Body Tonicity—Hyponatremia and Hypernatremia: Core Curriculum 2020. Am J Kidney Dis. 2020;75(2):272–86. Adrogué HJ, Tucker BM, Madias NE. Diagnosis and Management of Hyponatremia: A Review. JAMA. 2022;328(3):280–91. Lindner G, Funk GC. Hypernatremia in critically ill patients. J Crit Care. 2013;28(2):e21611–20. Xia YM, Wang S, Wu WD, et al. Association between serum sodium level trajectories and survival in patients with heart failure. ESC Heart Fail. 2023;10(1):255–63. Lu DY, Cheng HM, Cheng YL, et al. Hyponatremia and Worsening Sodium Levels Are Associated With Long-Term Outcome in Patients Hospitalized for Acute Heart Failure. J Am Heart Assoc. 2016;5(3):e002668. Gheorghiade M, Abraham WT, Albert NM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J. 2007;28(8):980–8. Cordova Sanchez A, Bhuta K, Shmorgon G, et al. The association of hyponatremia and clinical outcomes in patients with acute myocardial infarction: a cross-sectional study. BMC Cardiovasc Disord. 2022;22(1):276. Sciaccaluga C, Mandoli GE, Ghionzoli N, et al. Risk stratification in cardiogenic shock: a focus on the available evidence. Heart Fail Rev. 2022;27(4):1105–17. Samsky MD, Morrow DA, Proudfoot AG, et al. Cardiogenic Shock After Acute Myocardial Infarction: A Review. JAMA. 2021;326(18):1840–50. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–64. Pöss J, Köster J, Fuernau G, et al. Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol. 2017;69(15):1913–20. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726. Bratusch-Marrain PR, DeFronzo RA. Impairment of insulin-mediated glucose metabolism by hyperosmolality in man. Diabetes. 1983;32:1028–34. Druml W, Kleinberger G, Lenz K, et al. Fructose-induced hyperlactemia in hyperosmolar syndromes. Klin Wochenschr. 1986;64:615–8. Vedantam A, Robertson CS, Gopinath SP. Morbidity and mortality associated with hypernatremia in patients with severe traumatic brain injury. Neurosurg Focus. 2017;43(5):E2. Lenz K, Gössinger H, Laggner A, et al. Influence of hypernatremic- hyperosmolar state on hemodynamics of patients with normal and depressed myocardial function. Crit Care Med. 1986;14:913–4. Kozeny GA, Murdock DK, Euler DE, et al. In vivo effects of acute changes in osmolality and sodium concentration on myocardial contractility. Am Heart J. 1985;109:290–6. Kantrowitz A, Wasfie T, Freed PS, et al. Intraaortic balloon pumping 1967 through 1982: analysis of complications in 733 patients. Am J Cardiol. 1986;57(11):976–83. Biffi S, Di Bella S, Scaravilli V, et al. Infections during extracorporeal membrane oxygenation: epidemiology, risk factors, pathogenesis an prevention. Int J Antimicrob Agents. 2017;50(1):9–16. Yeoh SE, Docherty KF, Jhund PS, et al. Relationship of Dapagliflozin With Serum Sodium: Findings From the DAPA-HF Trial. JACC Heart Fail. 2022;10(5):306–18. Wu H, Bai M, Li X, et al. Diagnosis and treatment of brain injury complicated by hypernatremia. Front Neurol. 2022;13:1026540. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6812459","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484492975,"identity":"d510f1f9-a766-461a-b23b-600fd7c3e5f3","order_by":0,"name":"Qian-feng Xiao","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Qian-feng","middleName":"","lastName":"Xiao","suffix":""},{"id":484492976,"identity":"59495f2b-2cc7-4e34-958b-206f61a03b0b","order_by":1,"name":"Fang-yang Huang","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Fang-yang","middleName":"","lastName":"Huang","suffix":""},{"id":484492977,"identity":"6f63339e-0e71-45f5-b876-3aa26bf020ff","order_by":2,"name":"Si Wang","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Si","middleName":"","lastName":"Wang","suffix":""},{"id":484492978,"identity":"ac90a1ab-67d8-428c-890f-02c86ee315bb","order_by":3,"name":"Yan Yang","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Yang","suffix":""},{"id":484492979,"identity":"1ca8b276-4ac3-4972-a4bf-4a58c97da250","order_by":4,"name":"Ying Xu","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Xu","suffix":""},{"id":484492980,"identity":"890b0e7f-cc09-45b6-bd4a-53f5e8a4a757","order_by":5,"name":"Mao Chen","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Mao","middleName":"","lastName":"Chen","suffix":""},{"id":484492981,"identity":"2070c48a-bf9d-4c68-943c-f9c205c7a271","order_by":6,"name":"Xin Wei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtUlEQVRIiWNgGAWjYBADOTb29gPEKmYGk8Z8PGcSSNOSOE/CwYA4DfLu5w8+/MFwOL1NgiGB4UfFNsJaDM8kMxvzMBzObZNuPMDYc+Y2EVoaktmkGf/dzm2TOZDAzNhGjJb+x+w/fzDcTmeTSDAgTou8RDIbAw/D7QTitRhIPDaW5mH4b9gGDOSDRPlFvj/x4ccfDGny8u3tBx/8qCDGlgNInAM4FKHZ0kCUslEwCkbBKBjRAADvMzg4J+WxRAAAAABJRU5ErkJggg==","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Xin","middleName":"","lastName":"Wei","suffix":""}],"badges":[],"createdAt":"2025-06-03 14:38:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6812459/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6812459/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86765993,"identity":"4be84d73-1b71-4ef5-894a-d56a476a7c70","added_by":"auto","created_at":"2025-07-15 11:05:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29872,"visible":true,"origin":"","legend":"\u003cp\u003eStudy design.\u003c/p\u003e\n\u003cp\u003eAbbreviation: AMI=acute myocardial infarction. CS=cardiogenic shock. CPR= Cardiopulmonary resuscitation.\u003c/p\u003e","description":"","filename":"Onlinefigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6812459/v1/499adae6646b16ba4e48a930.png"},{"id":86765341,"identity":"d46c9d83-b044-48bf-8322-f91431d48587","added_by":"auto","created_at":"2025-07-15 10:57:17","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8337,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of admission serum sodium in AMI-CS patients.\u003c/p\u003e\n\u003cp\u003eAbbreviation: AMI-CS=cardiogenic shock followed by acute myocardial infarction.\u003c/p\u003e","description":"","filename":"Onlinefigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-6812459/v1/d6c6be7642fa66e7abc51221.png"},{"id":86767478,"identity":"fb37cc75-7ceb-4e88-bc7b-cf916eac6eff","added_by":"auto","created_at":"2025-07-15 11:13:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":8599,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier survival curve grouped by admission serum sodium levels in AMI-CS patients.\u003c/p\u003e\n\u003cp\u003eAbbreviation: AMI-CS=cardiogenic shock followed by acute myocardial infarction.\u003c/p\u003e","description":"","filename":"Onlinefigure3.png","url":"https://assets-eu.researchsquare.com/files/rs-6812459/v1/18fb118a499104717657d53c.png"},{"id":86765995,"identity":"aa92cfae-f8c4-4313-b077-ab792c03f824","added_by":"auto","created_at":"2025-07-15 11:05:17","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":14881,"visible":true,"origin":"","legend":"\u003cp\u003eHazard ratios for all-cause deaths during 30 days and after 30 days grouped by admission serum sodium levels.\u003c/p\u003e","description":"","filename":"OnlineFigure4.png","url":"https://assets-eu.researchsquare.com/files/rs-6812459/v1/31cadf9cb6a2da24a0d5f17c.png"},{"id":86765349,"identity":"47cac628-8a76-4212-9a2f-b12aa06a5e9b","added_by":"auto","created_at":"2025-07-15 10:57:17","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":17052,"visible":true,"origin":"","legend":"\u003cp\u003eRelationship between admission serum sodium level and mortality in AMI-CS patients.\u003c/p\u003e\n\u003cp\u003eAbbreviation: AMI-CS=cardiogenic shock followed by acute myocardial infarction.\u003c/p\u003e","description":"","filename":"OnlineFigure5.png","url":"https://assets-eu.researchsquare.com/files/rs-6812459/v1/74980698e095aa6d05061502.png"},{"id":86767484,"identity":"888829d4-0c01-43c9-abcc-82e2e9a81567","added_by":"auto","created_at":"2025-07-15 11:13:17","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":35477,"visible":true,"origin":"","legend":"\u003cp\u003eSubgroup analyses of all-cause deaths according to the admission serum sodium level[based on age(\u0026gt;65 vs. ≤65 years), gender (female vs. male), OHCA(yes vs. no), stroke history(yes vs. no), diabetes(female vs. male), serum creatinine(\u0026gt;132.6 umol/L vs. ≤132.6 umol/L), ventilation(yes vs. no), mechanical circulatory support(yes vs. no)].\u003c/p\u003e\n\u003cp\u003eAbbreviation: OHCA= out of hospital cardiac arrest.\u003c/p\u003e","description":"","filename":"Onlinefigure6.png","url":"https://assets-eu.researchsquare.com/files/rs-6812459/v1/5c263615c4320a8db65e3333.png"},{"id":87466805,"identity":"1429a9e4-b121-4d1d-afe5-9c4057269884","added_by":"auto","created_at":"2025-07-24 07:34:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1197898,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6812459/v1/62d8db2e-f1a2-4dfa-9a1d-e6a139f0ced1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship between admission serum sodium levels and mortality in patients with cardiogenic shock complicated by acute myocardial infarction","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSodium holds a pivotal position within the human body, serving as the principal extracellular cation and playing a fundamental role in modulating cell volume. The normal reference range for serum sodium level generally lies between 135.0 mmol/L and 145.0 mmol/L\u003csup\u003e1\u0026ndash;2\u003c/sup\u003e. Both hyponatremia and hypernatremia pose detrimental effects. Research has demonstrated that sodium imbalance represents a prevalent problem among hospitalized patients, with approximately 30\u0026ndash;40% being affected. In the context of critically ill patients, the serum sodium level can potentially serve as an indicator of the disease state\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Roughly 20% of such patients encounter hyponatremia, which impacts 35% of hospitalized patients and 11.2% of those in the intensive care unit (ICU) \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Hypernatremia, albeit less common, occurs at a rate of 2\u0026ndash;6% in ICU patients\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. It has been established that hypernatremia serves as an independent risk factor for augmented in-hospital and short-term mortality in non-cardiovascular critically ill patients in the ICU\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Analogously, hyponatremia has been linked to cardiovascular events and mortality in patients afflicted with heart failure\u003csup\u003e\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eCardiogenic shock (CS) is a primary cardiac disorder leading to hypotension and signs of organ hypoperfusion, occurring in the setting of normovolaemia or hypervolaemia. Epidemiological data regarding CS indicates that approximately 60\u0026ndash;80% of the cases are attributed to acute myocardial infarction (AMI). The thirty-day mortality rate among CS patients caused by AMI is around 40%, and the 1-year mortality rate nears 50%\u003csup\u003e11\u0026ndash;12\u003c/sup\u003e. Consequently, the identification of prognostic markers capable of guiding risk stratification and enhancing outcomes persists as a significant clinical conundrum for patients with cardiogenic shock following acute myocardial infarction (AMI -CS). Notably, there is a paucity of knowledge concerning the incidence and prognostic significance of dysnatremia in critically ill patients with AMI-CS admitted to the cardiac care unit (CCU). In the study, our objective is to investigate the correlation between admission serum sodium concentration and mortality rates among AMI-CS patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population and definitions\u003c/h2\u003e\u003cp\u003e This single-center retrospective cohort study was conducted from September 2018 to July 2023.The study included patients diagnosed with AMI-CS who received medical treatment at the West China Hospital of Sichuan University, renowned as the largest tertiary care hospital in the western region of China (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Patients met the following inclusion criteria: (a) AMI was diagnosed per the third universal definition of myocardial infarction\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e: acute myocardial injury with clinical evidence of acute myocardial ischemia (myocardial ischemic symptoms, new ischemic ECG changes, pathological Q waves, imaging evidence of new viable myocardium loss or regional wall motion abnormality consistent with ischemic etiology, or coronary thrombus identified by angiography/autopsy), and cardiac troponin elevation with at least one value\u0026thinsp;\u0026gt;\u0026thinsp;99th percentile upper reference limit. (b) cardiogenic shock: a primary cardiac disorder leading to hypotension (systolic blood pressure\u0026thinsp;\u0026lt;\u0026thinsp;90 mmHg, or vasopressors required to maintain systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;90 mmHg) and organ hypoperfusion signs (increased arterial lactate\u0026thinsp;\u0026gt;\u0026thinsp;2 mmol/L, oliguria, altered mental status, cold and clammy skin/extremities) in the state of normovolaemia or hypervolaemia\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. (c) cardiogenic shock stages B to E per the Society for Cardiovascular Angiography and Interventions (SCAI) criteria\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. The exclusion criteria were as follows: (a) cardiopulmonary resuscitation (CPR) time of \u0026gt;\u0026thinsp;30 minutes due to pre-admission cardiac arrest (b) CS due to mechanical complications post-AMI, (c) CS due to ventricular tachycardia storm,(d) shock from other etiologies (e.g., septic/hemorrhagic shock), and (e) age\u0026thinsp;\u0026gt;\u0026thinsp;90 years.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eBaseline data collection\u003c/h3\u003e\n\u003cp\u003eDemographic details, vital signs and medical history, along with information regarding mechanically supported therapies (such as mechanical circulatory and ventilation data), and the specific AMI type was from the hospital records. Laboratory parameters, with the admission serum sodium levels, were routinely assessed within 24 hours of admission, and baseline blood gas analysis and biochemical test results were obtained. The coronary angiography procedures data were sourced from corresponding images. Cardiac function including left ventricular ejection fraction(LVEF) was determined by echocardiography reports during admission. Cardiogenic shock scores(intra-aortic balloon pump in cardiogenic shock II, IABP SHOCK Ⅱ) were calculated according to the baseline data\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The IABPSHOCK Ⅱ scores were computed based on patients' baseline data at admission. These scores were evaluated with age, history of stroke, serum glucose, creatine, arterial lactate, and thrombolysis in myocardial infarction (TIMI) flow grade 3 achieved after percutaneous coronary intervention (PCI)\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eStudy endpoints\u003c/h3\u003e\n\u003cp\u003eThe primary endpoint was all-cause death from hospital admission to follow-up. Secondary endpoints were the occurrence of sepsis, the need for dialysis and the incidence of brain injury. Follow-up information was obtained through telephone conversations, review of medical charts, and outpatient consultations. The integrity and accuracy of all data were verified and supported by the official hospital records, ensuring the reliability and validity of the information collected for the study.\u003c/p\u003e\n\u003ch3\u003eEthics and patients’ consent\u003c/h3\u003e\n\u003cp\u003e The study was approved by the Ethics Committee of West China Hospital, Sichuan University (Chengdu, China; approval number: 2021\u0026ndash;1770) and has been registered with the China Clinical Trials Registry(registration number:ChiCTR2500099275, date: 2025-3-20).\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003ePatients were stratified into three groups based on admission serum sodium tertiles. The Kolmogorov\u0026ndash;Smirnov test was employed to assess data distribution. Variables were presented as the means and medians, or frequencies and percentages, together with their corresponding ranges. The analysis of variance or the Kruskal\u0026ndash;Wallis test was utilized across groups for continuous variables, and chi-squared or Fisher\u0026rsquo;s exact tests were applied to make comparisons of the qualitative variables among the groups. Survival rates were depicted in the form of Kaplan\u0026ndash;Meier plots, and intergroup differences were analyzed with the log-rank test. Associations between variables and endpoints were first evaluated via univariate Cox regression. Variables showing significant mortality association (p\u0026thinsp;\u0026lt;\u0026thinsp;0.10) in univariate tests were further analyzed using multivariate models. Additionally, the linearity assumption for the admission serum sodium levels and mortality was assessed. To investigate the potential heterogeneity in the impact of admission serum sodium levels on all-cause mortality, subgroup analyses were carried out. The subgroups comprised age categories (with a cut off 65 years), gender, out-of-hospital cardiac arrest (OHCA), stroke history, diabetes status, serum creatinine levels (with a cut off 132.6 \u0026micro;mol/L), ventilation status, and mechanical circulatory support. A two-sided P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was defined as statistically significant, while a P value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 was considered significant for interaction tests. All analyses were performed using Stata/MP 17.0, R package 4.1.0 and Prism 9.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA sum of 312 AMI-CS patients were included(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean serum sodium level was 140.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 mmol/L and the histogram depicted a broad dispersion of the admission sodium values. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The incidences of hypernatremia and hyponatremia were 11.2% and 12.2% correspondingly. In accordance with the admission serum sodium level, the patients were stratified into three distinct groups using tertiles: those with Na\u0026thinsp;\u0026lt;\u0026thinsp;137.9 mmol/L, 138.0\u0026thinsp;≦\u0026thinsp;Na\u0026thinsp;≦\u0026thinsp;141.2 mmol/L and Na\u0026thinsp;\u0026gt;\u0026thinsp;141.2 mmol/L. Baseline characteristics of each group are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of the patients was 67.6 years, with a total of 238 (76.0%) patients being male. Notably, there were no differences in age and sex distribution across groups. Upon admission, there were no discernible differences in systolic blood pressure (SBP), mean arterial pressure (MAP), or heart rate among patients. Moreover, no perceptible discrepancies were observed in the occurrence rates of comorbidities such as hypertension, Coronary artery disease(CAD), stroke, chronic kidney disease(CKD) and Peripheral Arterial Disease\u003cb\u003e(\u003c/b\u003ePAD), across the studied groups. However, the patients within the high serum sodium group exhibited a relatively elevated frequency of OHCA. The baseline lactate (3.85 mmol/L versus 4.10 mmol/L versus 6.77 mmol/L), serum creatinine (148.05 \u0026micro;mol/L versus 148.17 \u0026micro;mol/L versus 157.65 \u0026micro;mol/L), and troponin T (8662 ng/L versus 8274 ng/L versus 10000 ng/L) in the high serum sodium group were comparatively elevated in relation to those of the other two groups. Overall, 73.4% of the study patients were diagnosed with ST-segment elevation myocardial infarction (STEMI), among which 49.4% were specifically categorized as having anterior STEMI. Nevertheless, No significant statistical differences were detected across the groups. Furthermore, 76.0% of the patients required mechanical ventilation, and the group with serum sodium levels exceeding 141.2 mmol/L exhibited a relatively greater proportion of such cases. Moreover, 51.3% of the patients were provided with mechanical circulatory support, and the high serum sodium group demonstrated a higher prevalence of extracorporeal membrane oxygenation (ECMO) implantation. The ratios of patients who received coronary angiography, revascularization, coronary lesions and TIMI flow grade after PCI did not display any pronounced differences across the groups. In terms of the risk classifications of the IABPSHOCK II score, it was noted that the high serum sodium group manifested higher scores. Nevertheless, LVEF showed no significant intergroup differences.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline and clinical characteristics of patients stratified by admission serum sodium levels of AMI-CS patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eAdmission serum sodium level, mmol/L\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;312)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;137.9(n\u0026thinsp;=\u0026thinsp;105)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eNa\u0026thinsp;=\u0026thinsp;138.0-141.2(n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNa\u0026thinsp;\u0026gt;\u0026thinsp;141.2(n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eDemographic data\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e67.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e68.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e65.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e69.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e238/312(76.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e82/105(78.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80/103(77.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e76/104(73.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.641\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI, kg/㎡\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e23.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.064\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP, mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e92.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e92.8\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e94.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e90.6\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.321\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMAP, mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e72.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e72.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e72.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e70.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.229\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeart rate, bpm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e97.7\u0026thinsp;\u0026plusmn;\u0026thinsp;22.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e94.8\u0026thinsp;\u0026plusmn;\u0026thinsp;20.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e100.6\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e97.9\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.185\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOHCA(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e61/312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e10/105(9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20/103(19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31/104(29.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCardiovascular risk factors/CVD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e150/312(48.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e53/105(50.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e52/103(50.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45/104(43.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.486\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArterial hypertension(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e149/312(47.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e56/105(53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41/103(39.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e52/104(50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.127\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes mellitus(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e102/312(32.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e44/105(41.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e33/103(33.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24/104(23.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of CAD(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e61/312(19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e17/105(16.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20/103(19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24/104(23.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.455\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of Stroke(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e26/312(8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e5/105(4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7/103(6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14/104(13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.059\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyslipidemia(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e51/312(16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e17/105(16.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21/103(20.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14/104(13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.404\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnown of PAD(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e8/312(2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2/105(1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3/103(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3/104(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.871\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCKD(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e24/312(7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e8/105(7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10/103(9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6/108(5.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.568\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLaboratory results\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum sodium, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e140.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e135.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e139.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e145.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArterial lactate, mmol/l\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e4.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.77\u0026thinsp;\u0026plusmn;\u0026thinsp;4.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlucose, mmol/l\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e12.20\u0026thinsp;\u0026plusmn;\u0026thinsp;6.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e12.56\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12.20\u0026thinsp;\u0026plusmn;\u0026thinsp;5.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.505\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum creatinine, umol/l\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e149.29\u0026thinsp;\u0026plusmn;\u0026thinsp;112.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e148.05\u0026thinsp;\u0026plusmn;\u0026thinsp;117.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e148.17\u0026thinsp;\u0026plusmn;\u0026thinsp;126.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e157.65\u0026thinsp;\u0026plusmn;\u0026thinsp;76.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTnT, ng/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e10000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e8662\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8274\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNT-proBNP, ng/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e9628\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e9343\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8808\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10738\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.518\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSTEMI(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e229/312(73.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e77/105(73.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e70/103(68.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e82/104(78.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.208\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnterior STEMI(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e154/312(49.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e52/105(49.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47/103(45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e55/104(52.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.580\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVentilation(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e237/312(76.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e71/105(67.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e76/103(73.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e90/104(86.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCAG(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e284/312(91.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e97/107(92.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e92/103(89.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95/104(91.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.735\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCoronary lesions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.219\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMono vessel disease(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e79/283(27.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e25/97(25.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27/92(29.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e27/94(28.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBi vessel disease(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e81/283(28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e34/97(35.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18/92(19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e29/94(30.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMulti vessel disease(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e123/283(43.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e38/97(29.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47/92(51.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e38/94(40.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRevascularization(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e259/312(83.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e87/105(82.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e83/103(80.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e89/104(85.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.632\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompletely Revascularization(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e128/312(41.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e41/105(39.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40/103(38.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47/104(45.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.571\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTIMI flow grade\u0026thinsp;=\u0026thinsp;3 after PCI(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e238/283(84.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e78/97(80.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e81/92(88.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e79/94(84.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.424\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVasoactive drugs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e304/312(97.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e103/105(98.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e98/103(95.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e103/104(99.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.181\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIABP(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e151/312(48.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e45/105(42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e49/103(47.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e57/104(54.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.220\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eECMO(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e9/312(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2/105(1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0/103(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7/104(6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIABPSHOCK Ⅱ score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;2(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e194/312(62.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e78/105(74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73/103(70.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e43/104(41.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u0026ndash;4(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e88/312(28.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e18/105(17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23/103(22.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e47/104(45.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;9(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e30/312(9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e9/105 (8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7/103(6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14/104(13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLVEF,%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e40.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e39.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e40.3\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eAbbreviations: AMI-CS\u0026thinsp;=\u0026thinsp;cardiogenic shock followed by acute myocardial infarction. AMI\u0026thinsp;=\u0026thinsp;acute myocardial infarction. CS\u0026thinsp;=\u0026thinsp;cardiogenic shock. BMI\u0026thinsp;=\u0026thinsp;body mass index. SBP\u0026thinsp;=\u0026thinsp;systolic blood pressure. MAP\u0026thinsp;=\u0026thinsp;mean arterial pressure. bpm\u0026thinsp;=\u0026thinsp;beats per minute. OHCA\u0026thinsp;=\u0026thinsp;out of hospital cardiac arrest. CVD\u0026thinsp;=\u0026thinsp;coronary vascular disease. CAD\u0026thinsp;=\u0026thinsp;coronary artery disease. PAD\u0026thinsp;=\u0026thinsp;Peripheral artery disease. CKD\u0026thinsp;=\u0026thinsp;chronic kidney disease. TnT\u0026thinsp;=\u0026thinsp;troponin T. STEMI\u0026thinsp;=\u0026thinsp;st-segment elevation myocardial infarction. CAG\u0026thinsp;=\u0026thinsp;Coronary angiography. TIMI\u0026thinsp;=\u0026thinsp;Thrombolysis in Myocardial Infarction. PCI\u0026thinsp;=\u0026thinsp;percutaneous coronary intervention. IABP\u0026thinsp;=\u0026thinsp;intra-aortic balloon pump. ECMO\u0026thinsp;=\u0026thinsp;Extracorporeal membrane oxygenation. IABPSHOCK\u0026thinsp;=\u0026thinsp;Intra-aortic balloon pump in Cardiogenic Shock. LVEF\u0026thinsp;=\u0026thinsp;left ventricular ejection fraction.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe median follow-up duration was 291 days. A total of 162 individuals (51.9%) died, and among them, 133 cases (42.6%) occurred within the initial 30 days of the follow-up period. Additionally, 140 (44.9%) patients died due to cardiac-related causes (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The group with high serum sodium levels exhibited a greater all-cause mortality in comparison to the other two groups (62.5% vs. 44.7% vs. 48.6%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.026). The incidence rates of sepsis, dialysis, and brain injury in the hospital were 12.2%, 14.7%, and 4.2% correspondingly. Remarkably, the occurrence of sepsis, dialysis, and brain injury was more pronounced in the high serum sodium group, with respective rates of 15.4%, 18.3%, and 8.7% as opposed to the other groups. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe outcomes of the AMI- CS patients grouped by admission serum sodium levels .\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eAdmission serum sodium level, mmol/L\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal(n\u0026thinsp;=\u0026thinsp;312)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;137.9(n\u0026thinsp;=\u0026thinsp;105)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e138.0-141.2(n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;141.2(n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e162/312(51.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51/105(48.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46/103(44.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e65/104(62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCardiac death(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e140/312(44.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39/105(37.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45/103(43.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e56/104(53.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-cardiac death(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22/312(7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12/105(11.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1/103(1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9/104(8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSepsis in hospital(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38/312(12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12/103(11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10/103(9.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16/104(15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.440\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis in hospital(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46/312(14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14/105(13.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13/103(12.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19/104(18.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.458\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrain injury(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13/312(4.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1/105(0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3/103(2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9/104(8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eAbbreviation: AMI-CS\u0026thinsp;=\u0026thinsp;cardiogenic shock followed by acute myocardial infarction.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe Kaplan\u0026ndash;Meier survival curve (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) revealed that, in contrast to the other groups, the group with serum sodium level exceeding 141.2 mmol/L exhibited significantly elevated mortality rate (p\u0026thinsp;=\u0026thinsp;0.0088). After adjusting for variables such as age, SBP, heart rate, glucose, serum creatinine, TIMI flow grade post-PCI, and LVEF, admission sodium level, when regarded as a continuous variable, was found to be independently associated with mortality (HR\u0026thinsp;=\u0026thinsp;1.04, 95%CI\u0026thinsp;=\u0026thinsp;1.02\u0026ndash;1.05, p\u0026thinsp;=\u0026thinsp;0.025, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Subsequent Cox analyses demonstrated that an admission serum sodium level higher than 141.2 mmol/L could strongly predict mortality within 30 days(HR\u0026thinsp;=\u0026thinsp;1.69, 95%CI\u0026thinsp;=\u0026thinsp;1.11\u0026ndash;2.56, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), yet it seemed not to have an impact long-term mortality. Moreover, we explored the potential curved association between sodium levels and mortality. Our results disclosed a J-shaped association between admission serum sodium concentrations and all-cause mortality in AMI-CS patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariable and multivariable cox analyses in mortality of the AMI-CS patients.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u003cp\u003eUnivariable analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003eMultivariable analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eHR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eHR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.60(0.43\u0026ndash;0.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.03(1.02\u0026ndash;1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.04(1.02\u0026ndash;1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eSerum sodium levels, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.06(1.03\u0026ndash;1.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.04(1.01\u0026ndash;1.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eSBP, mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.98(0.97\u0026ndash;0.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.98(0.96\u0026ndash;0.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eHeart rate, bpm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.01(1.01\u0026ndash;1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.01(1.00-1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eVentilation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e5.42(3.07\u0026ndash;9.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.08(1.57\u0026ndash;6.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eArterial hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.71(1.25\u0026ndash;2.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.40(1.02\u0026ndash;1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eCKD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.73(1.03\u0026ndash;2.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eGlucose, mmol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.05(1.03\u0026ndash;1.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.04(1.01\u0026ndash;1.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eSerum creatinine, umol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2.61(2.04\u0026ndash;3.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.82(1.27\u0026ndash;2.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eRevascularization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.33(0.23\u0026ndash;0.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eTIMI flow grade\u0026thinsp;=\u0026thinsp;3 after PCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.27(0.18\u0026ndash;0.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.29(0.18\u0026ndash;0.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eIABP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.12(0.82\u0026ndash;1.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.475\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eECMO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2.11(0.99\u0026ndash;4.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eLVEF, %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.96(0.94\u0026ndash;0.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.98(0.96\u0026ndash;0.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: AMI-CS\u0026thinsp;=\u0026thinsp;cardiogenic shock followed by acute myocardial infarction. AMI\u0026thinsp;=\u0026thinsp;acute myocardial infarction. CS\u0026thinsp;=\u0026thinsp;cardiogenic shock. HR\u0026thinsp;=\u0026thinsp;Hazard ratio. SBP\u0026thinsp;=\u0026thinsp;systolic blood pressure. CKD\u0026thinsp;=\u0026thinsp;chronic kidney disease. TIMI\u0026thinsp;=\u0026thinsp;Thrombolysis in Myocardial Infarction. PCI\u0026thinsp;=\u0026thinsp;percutaneous coronary intervention. IABP\u0026thinsp;=\u0026thinsp;intra-aortic balloon pump. ECMO\u0026thinsp;=\u0026thinsp;Extracorporeal membrane oxygenation. LVEF\u0026thinsp;=\u0026thinsp;left ventricular ejection fraction.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe subgroup analysis revealed pronounced interactions between serum sodium levels and several factors in relation to mortality. Specially, there was a significant interaction with sex (\u003cem\u003ep\u003c/em\u003e for interaction\u0026thinsp;=\u0026thinsp;0.07), previous diabetes mellitus \u003cem\u003e(p\u003c/em\u003e for interaction\u0026thinsp;=\u0026thinsp;0.04) and the utilization of mechanical circulatory support (\u003cem\u003ep\u003c/em\u003e for interaction\u0026thinsp;=\u0026thinsp;0.018) for mortality. The connection between sodium levels and mortality was more prominent among male patients who were provided with mechanical circulatory support. In contrast, no such association could be detected among patients who had a prior history of diabetes mellitus (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur research is dedicated to exploring the relationship between serum sodium concentration and mortality in AMI-CS patients. The findings of our study unearthed a remarkable association that elevated admission serum sodium levels correlate robustly with a high mortality rate, especially within the first 30 days. Patients with serum sodium levels exceeding 141.2 mmol/L were at a substantially higher risk of mortality. Moreover, the connection between admission serum sodium levels and all-cause mortality was especially prominent in male patients without diabetes and those who received mechanical circulatory support. These findings suggest hypernatremia as a crucial independent predictor of a poor short-term prognosis, emphasizing its significance in contrast to hyponatremia at the time of admission.\u003c/p\u003e\u003cp\u003eSerum sodium concentration is of paramount importance in upholding the water and electrolyte balance within the human body. Dysnatremias, which are prevent electrolyte disturbances among hospitalized patients, typically originate from imbalances in the intake and loss of electrolyte-free water \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Maintaining an appropriate balance between water and serum sodium is crucial for the management of cardiovascular diseases as well as for intensive care patients. Roughly 20%-30% of heart failure (HF) patients exhibit dysnatremias upon admission, prompting the European Society of Cardiology heart failure guideline to recommend in-hospital monitoring of serum sodium level \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. In previous reports, the rates of hyponatremia and hypernatremia were recorded as 16.37% and 8.16% respectively in a cohort of 4760 heart failure patients\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Nevertheless, no studies have explored serum sodium concentrations in CS patients, particularly those caused by AMI. Our study ascertained that 11.2% of AMI-CS patients suffered from hyponatremia, a prevalence comparable to that of HF patients. However, hypernatremia was more common, affecting 12.8% of AMI-CS patients. The underlying cause of hypernatremia in these patients has not yet to be elucidated. It is hypothesized that increased activity in the sympathetic nervous and renin-angiotensin aldosterone systems in AMI-CS patients leads to elevated levels of aldosterone and subsequent sodium retention. Renal insufficiency, which impairs the kidney\u0026rsquo;s capacity for urine dilution and concentration, may precipitate significant water loss and cause hypernatremia\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Additionally, critically ill patients, who frequently necessitate ventilation or circulatory support, encounter challenges in accessing water, thereby further heightening the susceptibility to hypernatremia.\u003c/p\u003e\u003cp\u003eA recent study highlighted the association between trends in serum sodium levels and mortality in HF patients, demonstrating that both hyponatremia and hypernatremia are linked to elevated mortality rates\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. In particular, hyponatremia served as a predictor for extended hospital stays, along with elevated in-hospital mortality and higher post-discharge early mortality rates among heart failure patients \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Moreover, another study revealed the connection between admission hyponatremia and in-hospital as well as 30-day mortality in AMI patients\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Dysnatremia is also regarded as a prevalent electrolyte abnormality of patients in the ICU that can precipitate poor prognosis\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Previous research confirmed that both hyponatremia and hypernatremia independently contribute to higher in-hospital and 28-day mortality rates among ICU patients\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Our study unveiled a J-shaped association between admission serum sodium levels and all-cause death in patients with AMI-CS, with elevated admission serum sodium levels being linked to an\u003c/p\u003e\u003cp\u003eunfavorable prognosis, especially within initial 30 days. However, the underlying factors responsible for high serum sodium levels resulting in short-term mortality among CS patients remains ambiguous. Firstly, hypernatremia might exacerbate peripheral insulin resistance and hyperglycemia, thus impairing hepatic gluconeogenesis and lactate clearance,\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e evident from higher arterial lactate levels in our high serum sodium group. Secondly, hypernatremia can trigger neurological impairments, even after correction\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, as substantiated by a higher occurrence of brain injuries, OHCA, and strokes prior to admission in our high serum sodium group and previous studies \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Thirdly, reports suggest that hypernatremia could undermine cardiac function, with research indicating a negative inotropic effect on myocardial contractility in both humans and animals\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Lastly, hypernatremia typically signifies water loss and hypovolemia, further aggravating the shock experienced by AMI-CS patients.\u003c/p\u003e\u003cp\u003eThe stratified analyses indicated that, in comparison to patients without mechanical circulatory support, the association between admission serum sodium levels and mortality was potentially more pronounced among those who had such support. This finding demonstrated that CS patients who had been implanted with IABP or ECMO were likely to have relatively unfavorable prognoses in the presence of hypernatremia. One potential explanation is that patients with IABP or ECMO devices are often bedridden, making them susceptible to infections and sepsis\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, which are conditions associated with hypernatremia and poor outcomes. Intriguingly, our study revealed weaker relative mortality risk associations in AMI-CS patients with diabetes. The exact mechanism underlying this interaction association remained elusive. It is conceivable that the glucose levels in diabetic patients can induce osmotic dehydration, resulting in high serum sodium levels\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. However, these high sodium levels might not precisely mirror the true severity of their underlying condition\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Moreover, hypernatremia is linked to insulin resistance, this effect could be mitigated in diabetes patients due to their pre-existing insulin resistance. our sex-stratified analyses showed that, in male patients, the predictive power of admission serum sodium concentrations for mortality was more pronounced. The cause of this difference remained uncertain; one potential factor could be the higher incidence of circulatory mechanical support utilization among male patients in our study. Nevertheless, we cannot exclude the possibility of significant bias due to the relatively small sample size of female patients.\u003c/p\u003e\u003cp\u003eOur study could has the potential to establish appropriate serum sodium reference levels for AMI-CS patients, which could subsequently influence the clinical management of these patients. Based on the Kaplan\u0026ndash;Meier survival curve and the J-shaped association between serum sodium concentrations and mortality in AMI-CS patients, we deduced that the optimal serum sodium range for this population lies between 138.0 and 141.2 mmol/L. This information could prove invaluable for clinicians in rapidly stratifying the risk of AMI-CS patients, as serum sodium levels are easily measurable and readily accessible. We also anticipate that it could play a significant role in guiding clinical decision-making regarding the selection of management strategies for these patients. Traditionally, the treatment approach for CS has centered on attempts to utilize diuretics to reduce volume load while concurrently restricting fluid intake\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. However, for these patients with elevated serum sodium levels, caution must be exercised when considering the early use of loop diuretics, as this could exacerbate hypernatremia. Moreover, fluid intake should not be restricted in such cases. Additionally, the infusion of sodium-containing fluids in these CS patients ought to be limited. Some medications, like sodium glucose cotransporter 2(SLGT2) inhibitors such as dapagliflozin, might be beneficial for alleviating hypernatremia at an early stage in AMI-CS patients. This occurs because the initial osmotic and natriuretic diuresis triggered by SGLT2 inhibitors leads to an augmentation in vasopressin secretion and a decrease in free-water clearance\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. For AMI-CS with hypernatremia, continuous renal replacement therapy might be a more aggressive option, as it can slowly, controllably, and continuously lower blood sodium\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Nevertheless, whether these approaches are effective requires further clinical practice and research. This study had several limitations. Firstly, This was a single center, observational study with a relatively small sample size, which might have rendered it underpowered to detect certain differences. Secondly, despite our attempts to adjust for multiple factors, it was challenging to completely eliminate confounding variables with this experimental approach. Thirdly, the conclusions of this study were confined to the potential predictive role of elevated baseline serum sodium levels for short-term outcomes. It is crucial to emphasize that this does not imply improving prognoses by correcting hypernatremia disorders. Similarly, although our study identified that patients with serum sodium levels of 138.0 to 141.2 mmol/L exhibited the lowest mortality, this observation should not be used to dictate the management of serum sodium concentrations during hospitalization or long-term follow-up. Therefore, prospective and multicenter studies ought to be conducted in the future to explore whether active correction of hypernatremia can improve the outcomes of AMI-CS patients.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe results of this study demonstrated a J-shaped association between admission serum sodium concentrations and all-cause mortality for AMI-CS patients. Notably, within the cohort, elevated admission serum sodium concentrations were linked to all-cause mortality, especially 30-day mortality. This may be helpful for risk stratification and clinical decision making regarding the selection of management strategies for AMI-CS patients. Future research should explore how early correction of sodium imbalances impacts the prognoses of AMI-CS patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAMI\u003c/p\u003e\u003cp\u003eAcute myocardial infarction\u003c/p\u003e\u003cp\u003eAMI-CS\u003c/p\u003e\u003cp\u003eCardiogenic shock secondary to acute myocardial infarction\u003c/p\u003e\u003cp\u003eBMI\u003c/p\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003cp\u003eCAD\u003c/p\u003e\u003cp\u003eCoronary artery disease\u003c/p\u003e\u003cp\u003eCCU\u003c/p\u003e\u003cp\u003eCardiac care unit\u003c/p\u003e\u003cp\u003eCAD\u003c/p\u003e\u003cp\u003eCoronary artery disease\u003c/p\u003e\u003cp\u003eCPR\u003c/p\u003e\u003cp\u003eCardiopulmonary resuscitation\u003c/p\u003e\u003cp\u003eCS\u003c/p\u003e\u003cp\u003eCardiogenic shock\u003c/p\u003e\u003cp\u003eECMO\u003c/p\u003e\u003cp\u003eExtracorporeal membrane oxygenation\u003c/p\u003e\u003cp\u003eHF\u003c/p\u003e\u003cp\u003eHeart failure\u003c/p\u003e\u003cp\u003eIABPSHOCK II\u003c/p\u003e\u003cp\u003eIntra-aortic balloon pump in cardiogenic shock II\u003c/p\u003e\u003cp\u003eICU\u003c/p\u003e\u003cp\u003eIntensive care unit\u003c/p\u003e\u003cp\u003eLVEF\u003c/p\u003e\u003cp\u003eLeft ventricular ejection fraction\u003c/p\u003e\u003cp\u003eMAP\u003c/p\u003e\u003cp\u003eMean arterial pressure\u003c/p\u003e\u003cp\u003eOHCA\u003c/p\u003e\u003cp\u003eOut-of-hospital cardiac arrest\u003c/p\u003e\u003cp\u003ePCI\u003c/p\u003e\u003cp\u003ePercutaneous coronary intervention\u003c/p\u003e\u003cp\u003ePAD\u003c/p\u003e\u003cp\u003ePeripheral artery disease\u003c/p\u003e\u003cp\u003eSBP\u003c/p\u003e\u003cp\u003eSystolic blood pressure\u003c/p\u003e\u003cp\u003eSCAI\u003c/p\u003e\u003cp\u003eSociety for Cardiovascular Angiography and Interventions\u003c/p\u003e\u003cp\u003eSLGT2\u003c/p\u003e\u003cp\u003eSodium glucose cotransporter 2\u003c/p\u003e\u003cp\u003eSTEMI\u003c/p\u003e\u003cp\u003eST-segment elevation myocardial infarction\u003c/p\u003e\u003cp\u003eTIMI\u003c/p\u003e\u003cp\u003eThrombolysis in myocardial infarction\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiao Qianfeng: Conceptualization,\u0026nbsp;Methodology, Software, Formal analysis, Writing- Original draft preparation. Huang Fangyang: Conceptualization, Methodology, Software, Writing- Reviewing and Funding acquisition. Wang Si:\u003cem\u003e\u0026nbsp;\u003c/em\u003eFormal analysis, Funding acquisition. Yang Yan: Data curation. Xu Ying: Project administration. Chen Mao: Supervision, Project administration. Wei Xin:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eValidation, Visualization, Investigation, Project administration, Writing- Reviewing and Editing. All authors have participated in the study as well as contributed to the drafting and approval of the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Sichuan Science and Technology Program (Grant Numbers: 2023NSFSC0581 and 2023YFS0296).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used and/or analyzed in this study are available from the corresponding author opon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of West China Hospital, Sichuan University (Chengdu, China; approval number: 2021\u0026ndash;1770). All participants gave written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare there are no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSterns RH. Disorders of Plasma Sodium \u0026mdash; Causes, Consequences, and Correction. N Engl J Med. 2015;372(1):55\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSakr Y, Rother S, Ferreira AM, et al. Fluctuations in Serum Sodium Level Are Associated With an Increased Risk of Death in Surgical ICU Patients. Crit Care Med. 2013;41(1):133\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQi Z, Lu J, Liu P, et al. Nomogram Prediction Model of Hypernatremia on Mortality in Critically Ill Patients. infect Drug Resist. 2023;16:143\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeay NW, Lehrich RW, Greenberg A. Diagnosis and Management of Disorders of Body Tonicity\u0026mdash;Hyponatremia and Hypernatremia: Core Curriculum 2020. Am J Kidney Dis. 2020;75(2):272\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdrogu\u0026eacute; HJ, Tucker BM, Madias NE. Diagnosis and Management of Hyponatremia: A Review. JAMA. 2022;328(3):280\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLindner G, Funk GC. Hypernatremia in critically ill patients. J Crit Care. 2013;28(2):e21611\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXia YM, Wang S, Wu WD, et al. Association between serum sodium level trajectories and survival in patients with heart failure. ESC Heart Fail. 2023;10(1):255\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLu DY, Cheng HM, Cheng YL, et al. Hyponatremia and Worsening Sodium Levels Are Associated With Long-Term Outcome in Patients Hospitalized for Acute Heart Failure. J Am Heart Assoc. 2016;5(3):e002668.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGheorghiade M, Abraham WT, Albert NM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J. 2007;28(8):980\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCordova Sanchez A, Bhuta K, Shmorgon G, et al. The association of hyponatremia and clinical outcomes in patients with acute myocardial infarction: a cross-sectional study. BMC Cardiovasc Disord. 2022;22(1):276.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSciaccaluga C, Mandoli GE, Ghionzoli N, et al. Risk stratification in cardiogenic shock: a focus on the available evidence. Heart Fail Rev. 2022;27(4):1105\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSamsky MD, Morrow DA, Proudfoot AG, et al. Cardiogenic Shock After Acute Myocardial Infarction: A Review. JAMA. 2021;326(18):1840\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018;72(18):2231\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eP\u0026ouml;ss J, K\u0026ouml;ster J, Fuernau G, et al. Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol. 2017;69(15):1913\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599\u0026ndash;726.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBratusch-Marrain PR, DeFronzo RA. Impairment of insulin-mediated glucose metabolism by hyperosmolality in man. Diabetes. 1983;32:1028\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDruml W, Kleinberger G, Lenz K, et al. Fructose-induced hyperlactemia in hyperosmolar syndromes. Klin Wochenschr. 1986;64:615\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVedantam A, Robertson CS, Gopinath SP. Morbidity and mortality associated with hypernatremia in patients with severe traumatic brain injury. Neurosurg Focus. 2017;43(5):E2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLenz K, G\u0026ouml;ssinger H, Laggner A, et al. Influence of hypernatremic- hyperosmolar state on hemodynamics of patients with normal and depressed myocardial function. Crit Care Med. 1986;14:913\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKozeny GA, Murdock DK, Euler DE, et al. In vivo effects of acute changes in osmolality and sodium concentration on myocardial contractility. Am Heart J. 1985;109:290\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKantrowitz A, Wasfie T, Freed PS, et al. Intraaortic balloon pumping 1967 through 1982: analysis of complications in 733 patients. Am J Cardiol. 1986;57(11):976\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBiffi S, Di Bella S, Scaravilli V, et al. Infections during extracorporeal membrane oxygenation: epidemiology, risk factors, pathogenesis an prevention. Int J Antimicrob Agents. 2017;50(1):9\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYeoh SE, Docherty KF, Jhund PS, et al. Relationship of Dapagliflozin With Serum Sodium: Findings From the DAPA-HF Trial. JACC Heart Fail. 2022;10(5):306\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu H, Bai M, Li X, et al. Diagnosis and treatment of brain injury complicated by hypernatremia. Front Neurol. 2022;13:1026540.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cardiogenic shock, serum sodium level, hypernatremia, mortality","lastPublishedDoi":"10.21203/rs.3.rs-6812459/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6812459/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSerum sodium plays an important role in hospitalized patients, but the impact of serum sodium levels on mortality in cardiogenic shock followed by acute myocardial infarction (AMI-CS) patients has not been evaluated. This study was designed to assess the serum sodium levels on mortality in patients with AMI-CS.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe enrolled and completed the follow-up of 312 patients with AMI-CS. The primary endpoint was all-cause mortality. Patients were divided into three groups by tertiles based on admission serum sodium levels. The prognostic value of admission serum sodium levels was evaluated using Kaplan\u0026ndash;Meier survival curves and Cox regression, and the linearity assumption for admission serum sodium levels and mortality was evaluated. Subgroup analyses were also performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eCompared to individuals exhibiting sodium levels ranging from 138.0 to 141.2 mmol/L, patients with sodium levels\u0026thinsp;\u0026gt;\u0026thinsp;141.2 mmol/L demonstrated comparable long-term mortality rates but a heightened short-term mortality risk. Additionally, a J-shaped association was observed between admission serum sodium levels and mortality. The subgroup analysis suggested that sex, diabetes, and utilization of mechanical circulatory support exert influenced the association between admission serum sodium levels and mortality in AMI-CS patients.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eElevated admission serum sodium levels were identified as an independent predictor of mortality, particularly within the initial 30-day, among AMI-CS patients. The findings underscore the crucial clinical significance of effectively managing serum sodium levels in AMI-CS patients.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003eChiCTR2500099275 (2025-3-20).\u003c/p\u003e","manuscriptTitle":"Relationship between admission serum sodium levels and mortality in patients with cardiogenic shock complicated by acute myocardial infarction","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 10:57:12","doi":"10.21203/rs.3.rs-6812459/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-07-28T14:55:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-23T10:08:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295004367538825327660851093454314604862","date":"2025-07-19T08:22:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-18T08:08:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-17T11:09:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95401716433122939139971047689763866162","date":"2025-07-17T09:43:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50379538860809534321595505070128299138","date":"2025-07-17T08:08:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6385160333597309492021300444616108569","date":"2025-07-17T07:50:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-16T08:36:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54214535493606631871768974640799425965","date":"2025-07-10T17:52:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-10T13:26:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-07T10:33:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-17T07:38:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-17T07:24:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-06-17T07:20:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"62f651bf-58f8-437c-8de6-141586b70a6b","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-15T10:57:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 10:57:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6812459","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6812459","identity":"rs-6812459","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}