Cortisol level predicts myocardial infarction in patients with ischaemic chest pain.

Serum cortisol levels were studied in twenty patients with confirmed myocardial infarction and in twenty patients with severe chest pain admitted to the coronary care unit with suspected myocardial infarction but in whom a diagnosis of angina was subsequently made. Cortisol levels were significantly elevated in patients within five hours of the onset of symptoms in myocardial infarction (857 +/- 74 nmol/l; mean +/- SE) but remained within the normal range for those with angina (340 +/- 55 nmol/l). It is concluded that hypercortisolaemia accompanies myocardial infarction, but not angina, and that the psychological stresses of ischaemic chest pain and admission to the coronary care unit produce little, if any, elevation in serum cortisol levels unless there is significant myocardial necrosis. This observation may be of value to those conducting intervention studies in myocardial infarction since the early elevation of the cortisol levels to above the normal range in patients with ischaemic chest pain is both sensitive (70%) and specific (85%) for myocardial infarction.