Restricted accessResearch articleFirst published online 2018-9
Potassium Fluctuations Are Associated With Inhospital Mortality From Acute Myocardial Infarction. Soroka Acute Myocardial Infarction II (SAMI-II) Project
Potassium levels (K, mEq/L) fluctuate in patients with acute myocardial infarction (AMI). Potassium was reported to be associated with prognosis in patients with AMI; however, studies evaluating the prognostic value of K fluctuations in this setting are scarce. We retrospectively analyzed patients with AMI hospitalized in a tertiary medical center, through 2002 to 2012. Patients on chronic dialysis or mechanical ventilation were excluded. Based on all K values during hospitalization, minimal, maximal, and fluctuation (gap between 2 consecutive K) were recorded. Primary outcome was inhospital all-cause mortality. Overall, 10 032 patients were studied (age 68.1 ± 14.3 years, 65.4% males, 44.2% ST-segment elevation MI), of which 507 (3.7%) died in hospital. Potassium decreased during the first 2 to 3 days (P for trend <.001), followed by stabilization (P for trend = .807). Potassium in the extreme categories (<3.8 and ≥4.7) and absolute fluctuations >0.1 mEq/L were more common among nonsurvivors than survivors (P < .001 each). In a multivariate analysis, combinations of minimal K <3.8 with maximal K ≥4.7 (odds ratio [OR] = 18.1), K ≥4.4 with fluctuation ≥0.1 (OR = 1.74), or <−0.1 (OR = 2.6) and minimal K after the first 2 admission days (OR = 2.07) were associated with increased risk of mortality (P < .001 each). Potassium fluctuations, peak and nadir K, and its timing independently predict inhospital mortality in patients with AMI.
MacdonaldJEStruthersAD. What is the optimal serum potassium level in cardiovascular patients?J Am Coll Cardiol. 2004;43(2):155–161.
2.
Al-QuthamiAHUdelsonJE. What is the “goal” serum potassium level in acute myocardial infarction?Am J Kidney Dis. 2012;60(4):517–520.
3.
GrumbachLHowardJWMerrillVI. Factors related to the initiation of ventricular fibrillation in the isolated heart; effect of calcium and potassium. Circ Res. 1954;2(5):452–459.
4.
HultingJ. In-hospital ventricular fibrillation and its relation to serum potassium. Acta Med Scand Suppl. 1981;647:109–116.
5.
NordrehaugJEJohannessenKAvon der LippeG. Serum potassium concentration as a risk factor of ventricular arrhythmias early in acute myocardial infarction. Circulation. 1985;71(4):645–649.
6.
NordrehaugJEvon der LippeG. Hypokalaemia and ventricular fibrillation in acute myocardial infarction. Br Heart J. 1983;50(6):525–529.
7.
AntmanEMAnbeDTArmstrongPW; American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J Am Coll Cardiol. 2004;44(3):E1–E211.
8.
CohnJNKoweyPRWheltonPKPrisantLM. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice. Arch Intern Med. 2000;160(16):2429–2436.
9.
ShiyovichAGilutzHPlakhtY. Serum potassium levels and long-term post-discharge mortality in acute myocardial infarction. Int J Cardiol. 2014;172(2):e368–e370.
10.
GoyalASpertusJAGoschK. Serum potassium levels and mortality in acute myocardial infarction. JAMA. 2012;307(2):157–164.
11.
UluganyanMEkmekciAMuratA. Admission serum potassium level is associated with in-hospital and long-term mortality in ST-elevation myocardial infarction. Anatol J Cardiol. 20166(1):10–15.
12.
ChoiJSKimYAKimHY. Relation of serum potassium level to long-term outcomes in patients with acute myocardial infarction. Am J Cardiol. 2014;113(8):1285–1290.
13.
HondaTFujimotoKMiyaoYKogaHIshiiM. Potassium concentration on admission is an independent risk factor for target lesion revascularization in acute myocardial infarction. Sci World J. 2014;2014:946803.
14.
PengYHuangFYLiuW. Relation between admission serum potassium levels and long-term mortality in acute coronary syndrome. Intern Emerg Med. 2015;10(8):927–935.
15.
ShiyovichAPlakhtY. MyoK+ardial Infarction: potassium levels and outcomes following acute myocardial infarction. Angiology. 2016;67(8):725–728.
16.
ShlomaiGBerkovitchAPinchevski-KadirS. The association between normal-range admission potassium levels in Israeli patients with acute coronary syndrome and early and late outcomes. Medicine (Baltimore). 2016;95(23):e3778.
17.
WaliMVYatirajS. Study of serum sodium and potassium in acute myocardial infarction. J Clin Diag Res. 2014;8(11):CC07–CC09.
18.
OliverMF.Metabolic response during impending myocardial infarction. II. Clinical implications. Circulation. 1972;45(2):491–500.
19.
BrownMJBrownDCMurphyMB. Hypokalemia from beta2-receptor stimulation by circulating epinephrine. N Engl J Med. 1983;309(23):1414–1419.
20.
SekiyamaHNagoshiTKomukaiK. Transient decrease in serum potassium level during ischemic attack of acute coronary syndrome: paradoxical contribution of plasma glucose level and glycohemoglobin. Cardiovasc Diabetol. 2013;12:4.
21.
PlakhtYGilutzHShiyovichA. Ethnical disparities in temporal trends of acute myocardial infarction (AMI) throughout a decade in Israel. Soroka acute myocardial infarction (SAMI-II) project. Int J Cardiol. 2016;214:469–476.
22.
PlakhtYGilutzHShiyovichA. Decreased admission serum albumin level is an independent predictor of long-term mortality in hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction II (SAMI-II) project. Int J Cardiol. 2016;219:20–24.
23.
PlakhtYGilutzHShiyovichA. Temporal trends in acute myocardial infarction: What about survival of hospital survivors? Disparities between STEMI & NSTEMI remain. Soroka acute myocardial infarction II (SAMI-II) project. Int J Cardiol. 2016;203:1073–1081.
24.
LeveyASStevensLASchmidCH. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–612.
25.
FooKSekhriNDeanerA. Effect of diabetes on serum potassium concentrations in acute coronary syndromes. Heart. 2003;89(1):31–35.
26.
KokotFHyla-KlekotL. Drug-induced abnormalities of potassium metabolism. Pol Arch Intern Med. 2008;118(7-8):431–443.
27.
SalahKPintoYMEurlingsLW. Serum potassium decline during hospitalization for acute decompensated heart failure is a predictor of 6-month mortality, independent of N-terminal pro-B-type natriuretic peptide levels: an individual patient data analysis. Am Heart J. 2015;170:531–542 e1.
28.
FitzovichDEHamaguchiMTullWBYoungDB. Chronic hypokalemia and the left ventricular responses to epinephrine and preload. J Am Coll Cardiol. 1991;18(4):1105–1111.
29.
ShapiroJIBanerjeeAReissOKElkinsN. Acute and chronic hypokalemia sensitize the isolated heart to hypoxic injury. Am J Physiol. 1998;274(5 pt 2):H1598–H1604.
30.
GoldbergRJYarzebskiJSpencerFAZevallosJCLessardDGoreJM. Thirty-year trends (1975-2005) in the magnitude, patient characteristics, and hospital outcomes of patients with acute myocardial infarction complicated by ventricular fibrillation. Am J Cardiol. 2008;102(12):1595–1601.
31.
RoosMNdrepepaGBaumannM. Serum potassium levels on admission and infarct size in patients with acute myocardial infarction. Clin Chim Acta. 2009;409(1-2):46–51.
32.
PasdoisPBeauvoitBCostaAD. Sarcoplasmic ATP-sensitive potassium channel blocker HMR1098 protects the ischemic heart: implication of calcium, complex I, reactive oxygen species and mitochondrial ATP-sensitive potassium channel. J Mol Cell Cardiol. 2007;42(3):631–642.
33.
TsuchidaAMiuraTTannoM. Infarct size limitation by nicorandil: roles of mitochondrial K(ATP) channels, sarcolemmal K(ATP) channels, and protein kinase C. J Am Coll Cardiol. 2002;40(8):1523–1530.
34.
LiQYMacAulayMALandymoreRW. Morphometric analysis on myocardial injury related to the use of high volume potassium cardioplegic solution during ischemic arrest. Pathol Res Pract. 1992;188(4-5):668–671.
