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We investigated the recovery pattern from acute kidney injury (AKI) following acute myocardial infarction (AMI) and its association with long-term mortality. The retrospective study included AMI patients (2002–2027), who developed AKI during hospitalization. Creatinine (Cr) measurements were collected and categorized into 24 h timeframes up to 7 days from AKI diagnosis. The following groups of recovery patterns were defined: rapid (24–48 h)/no rapid and early (72–144 h)/no early recovery. Specific cut-off points for recovery at each AKI stage and timeframe were determined through receiver operating characteristic (ROC) curves. The probability of long-term (up to 10 years) mortality as a post-AKI recovery was investigated using a survival approach. Out of 17,610 AMI patients, 1069 developed AKI. For stage 1 AKI, patients with a Cr ratio <1.5 at 24 h and/or <1.45 at 48 h were defined as 'rapid recovery'; for stages 2–3 AKI, a Cr ratio <2.5 at 96 h was defined as 'early recovery'. Mortality risk in stage 1 AKI was higher among the non-rapidly recovered: AdjHR = 1.407; 95% CI: 1.086–1.824; p = 0.010. Among stages 2–3 AKI patients, the risk for long-term mortality was higher among patients who did not recover in the early period: AdjHR = 1.742; 95% CI: 1.085–2.797; p = 0.022. The absence of rapid recovery in stage 1 AKI and lack of early recovery in stages 2–3 AKI are associated with higher long-term mortality. [ABSTRACT FROM AUTHOR]

Aims We examined whether thickness of the basal muscular interventricular septum (IVS), as measured by pre-procedural computed tomography (CT), could be used to identify the risk of conduction disturbances following transcatheter aortic valve replacement (TAVR). The IVS is a pivotal region of the electrical conduction system of the heart where the atrioventricular conduction axis is located. Methods and results Included were 78 patients with severe aortic stenosis who underwent CT imaging prior to TAVR. The thickness of muscular IVS was measured in the coronal view, in systolic phases, at 1, 2, 5, and 10 mm below the membranous septum (MS). The primary endpoint was a composite of conduction disturbance following TAVR. Conduction disturbances occurred in 24 out of 78 patients (30.8%). Those with conduction disturbances were significantly more likely to have a thinner IVS than those without conduction disturbances at every measured IVS level (2.98 ± 0.52 mm vs. 3.38 ± 0.52 mm, 4.10 ± 1.02 mm vs. 4.65 ± 0.78 mm, 6.11 ± 1.12 mm vs. 6.88 ± 1.03 mm, and 9.72 ± 1.95 mm vs. 10.70 ± 1.55 mm for 1, 2, 5 and 10 mm below MS, respectively, P < 0.05 for all). Multivariable logistic regression analysis showed that pre-procedural IVS thickness (<4 mm at 2 mm below the MS) was a significant independent predictor of post-procedural conduction disturbance (adjOR 7.387, 95% CI: 2.003–27.244, P = 0.003). Conclusion Pre-procedural CT assessment of basal IVS thickness is a novel predictive marker for the risk of conduction disturbances following TAVR. The IVS thickness potentially acts as an anatomical barrier protecting the underlying conduction system from mechanical compression during TAVR. [ABSTRACT FROM AUTHOR]

Healthcare resource utilization (HRU) peaks in the last year-of-life, and accounts for a substantial share of healthcare expenditure. We evaluated changes in HRU and costs throughout the last year-of-life among AMI survivors and investigated whether such changes can predict imminent mortality. This retrospective analysis included patients who survived at least one year following an AMI. Mortality and HRU data during the 10-year follow-up period were collected. Analyses were performed according to follow-up years that were classified into mortality years (one year prior to death) and survival years. Overall, 10,992 patients (44,099 patients-years) were investigated. Throughout the follow-up period, 2,885 (26.3%) patients died. The HRU parameters and total costs were strong independent predictors of mortality during a subsequent year. While a direct association between mortality and hospital services (length of in-hospital stay and emergency department visits) was observed, the association with ambulatory services utilization was reversed. The discriminative ability (c-statistics) of a multivariable model including the HRU parameters for predicting the mortality in the subsequent year, was 0.88. In conclusion, throughout the last year of life, hospital-centered HRU and costs of AMI survivors increase while utilization of ambulatory services decrease. HRUs are strong and independent predictors of an imminent mortality year among these patients. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) recurrence following pulmonary vein isolation (PVI) ablation has clinical significance. Identifying risk factors for AF recurrence is important. We investigated serum albumin (SA) levels (g/dL) as a prognostic factor for the recurrence of AF following cryoballoon PVI ablation. Methods: We included patients who underwent cryoballoon PVI ablation at our institution between the years 2013 and 2018. The primary outcome was recurrence of AF during follow up. Results: Our cohort consisted of 126 patients (67% males, mean age 61.8 ± 10.0 years). The pattern of AF amongst the cohort was paroxysmal in 62.5%, persistent in 25.4%, and longstanding persistent in 6.3%. Those with lower SA levels had a mean AF duration significantly less than those with higher SA levels (2.81 years, 7.34 years, and 6.37 years for SA levels of <3.8, 3.8–4.1, and ≥4.1, respectively; p = 0.003). Patients with lower SA levels were significantly more likely to have had more previous cardioversions and a larger left atrial area and volume. The mean follow-up was 380 days, in which the AF recurrence rate was 20.6%. Patients with lower SA level had significantly more AF recurrences (47.4%, 16.7%, and 2.2% for SA levels of <3.8, 3.8–4.1, and ≥4.1, respectively; p < 0.001). Upon multivariate analysis, an SA level < 3.8 was associated with a higher risk of AF recurrence (OR = 5.422 95% CI 1.134; 25.910; p < 0.001). Conclusion: SA levels were found to be a strong independent marker for AF recurrence following PVI ablation. [ABSTRACT FROM AUTHOR]

To develop a prognostic tool to predict the live birth rate in cases of repeated pregnancy losses. A retrospective cohort study including patients treated in the dedicated RPL clinic between 2000 and 2015. Background data was collected in the primary visit via questionnaires and medical records. The recurrent pregnancy loss workup includes a genetic testing, endocrine testing, and anatomic abnormalities as well as thrombophilia.The prognostic tool took into account the unique contribution of the different risk factors, including maternal age, number of pregnancy losses, primary vs. secondary RPL and positive RPL workup. A total of 675 women were included in the study. The live birth rate was 72% (484). It was significantly associated with age (p=.002), number of previous pregnancy losses (p=.016), primary and secondary RPL and positive RPL workup. Each variable was assigned points according to the odds ratio found in the logistic regression to create two prediction models, before and after the RPL workup. Both models show a rise in the live birth rate as the score increases. We constructed a proposed innovative prognostic tool to predict the chance of a live birth on the consecutive pregnancy following the visit to the RPL clinic. Locating, identifying and improving risk assessment can enable the provision of up-to-date information to couples and the treating staff. This knowledge will reduce stress among the patients and will allow the staff to constructed custom intervention programs. [ABSTRACT FROM AUTHOR]

Aims Many patients admitted with acute myocardial infarction (AMI) have considerable multimorbidity, sometimes associated with functional limitations. The Norton Scale Score (NSS) evaluates clinical aspects of well-being and predicts numerous clinical outcomes. We evaluated the association between NSS and long-term healthcare utilization (HU) following a non-fatal AMI. Methods and results A retrospective observational study including AMI survivors during 1 January 2004 to 31 December 2015 with a filled NSS report. Data were recouped from the electronic medical records of the hospital and two Health Maintenance Organizations. Norton Scale Score ≤16 or >16 was defined as low or high respectively. The outcome was annual HU, encompassing length of hospital stay (LOS), emergency department (ED) visits, primary care, and other ambulatory service utilization during up to 10 years of follow-up. HU costs were compared between groups. Two-level models were built: unadjusted and adjusted for patients' baseline characteristics. The study included 4613 patients, 784 (17%) had low NSS. Patients with low NSS compared with patients with high NSS were older, had a higher rate of multimorbidity, and had significantly lower coronary angiography and revascularization rates. In addition, low NSS patients presented higher annual HU costs (4879 vs. 3634 Euro, P <0.001), primarily due to LOS, ED visits, and less frequent ambulatory services usage. Conclusion In patients after non-fatal AMI, low NSS is a signal for higher long-term costs reflecting the presence of expensive comorbidities. Management disparity and impaired mobility may offset the real need of these patients. Therefore, the specific proactive nursing intervention in that population is recommended. [ABSTRACT FROM AUTHOR]

Fasting throughout the Muslim month of Ramadan may impact cardiovascular health. This study examines the association between the Ramadan period and acute myocardial infarction (AMI)-related outcomes among a Muslim population. The data were retrospectively extracted from a tertiary hospital (Beer-Sheva, Israel) database from 2002–2017, evaluating Muslim patients who endured AMI. The study periods for each year were: one month preceding Ramadan (reference period (RP)), the month of Ramadan, and two months thereafter (1840 days in total). A comparison of adjusted incidence rates between the study periods was performed using generalized linear models; one-month post-AMI mortality data were compared using a generalized estimating equation. Out of 5848 AMI hospitalizations, 877 of the patients were Muslims. No difference in AMI incidence between the Ramadan and RP was found (p = 0.893). However, in the one-month post-Ramadan period, AMI incidence demonstrably increased (AdjIRR = 3.068, p = 0.018) compared to the RP. Additionally, the highest risk of mortality was observed among the patients that underwent AMI in the one-month post-Ramadan period (AdjOR = 1.977, p = 0.004) compared to the RP. The subgroup analyses found Ramadan to differentially correlate with AMI mortality with respect to smoking, age, sex, diabetes mellitus, and hypertension, suggesting the Ramadan period is a risk factor for adverse AMI-related outcomes among select Muslim patients. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) in a setting of acute myocardial infarction (AMI) is associated with significant metabolic changes and worse outcomes. Objective: To evaluate the prevalence and the prognostic significance of electrolyte/metabolite disturbances among AMI patients with vs. without DM. Methods: Patients admitted to a tertiary medical center with AMI throughout 2002–2012 were screened. Exclusion criteria were: dialysis, mechanical ventilation, and in-hospital coronary artery bypass graft (CABG) surgery. All the results of the following analyses were obtained: Glucose, Uric Acid, (UA) Calcium, Magnesium, Albumin, Potassium, and Sodium. The primary outcome was in-hospital all-cause mortality. Results: A total of 14,364 AMI patient admissions was evaluated, mean age 68.1 ± 14.4 years, 65.5% males, and 41.2% with DM. Following an adjustment to potential confounders, DM patients had increased risk for significant hyperglycemia, hyperuricemia, hypercalcemia, hypomagnesemia, hyperkalemia, and hyponatremia as well as significantly decreased risk for hypoglycemia, hypermagnesemia, and hypokalemia compared with nondiabetics. Overall, 681 (4.7%) patients died throughout the index admission. Deceased had an increased incidence of electrolyte/metabolite abnormalities versus hospital survivors. The prognostic significance of the different categories of the investigated variables is very similar among diabetics and nondiabetics, except increased and decreased uric acid levels [<4.5 (men); <4.0 (women) and ≥9.0 (men); ≥9.4 (women)] which are associated with worse outcomes among diabetics while hyperglycemia (Glucose ≥213 mg/dL) and increased Potassium levels (Potassium ≥4.4mEq/L) which comprise significantly worse prognosis among nondiabetics. Conclusions: Patients with DM admitted with AMI are at greater risk for electrolyte/metabolite abnormalities which are associated with increased risk for in-hospital mortality. The latter association is similar among patients with and without DM except for hyperglycemia and increased potassium levels (stronger among nondiabetics). [ABSTRACT FROM AUTHOR]

Abstract Background The Dead Sea region, the lowest in the world at 410 meters below sea level, is considered a potent climatotherapy center for the treatment of different chronic diseases. Objective To assess the prevalence of chronic diseases and the quality of life of residents of the Dead Sea region compared with residents of the Ramat Negev region, which has a similar climate, but is situated 600 meters above sea level. Methods An observational study based on a self-administered questionnaire. Data were collected from kibbutz (communal settlement) members in both regions. Residents of the Dead Sea were the study group and of Ramat Negev were the control group. We compared demographic characteristics, the prevalence of different chronic diseases and health-related quality of life (HRQOL) using the SF-36 questionnaire. Results There was a higher prevalence of skin nevi and non-inflammatory rheumatic diseases (NIRD) among Dead Sea residents, but they had significantly higher HRQOL mean scores in general health (68.7 ± 21 vs. 64.4 ± 22, p = 0.023) and vitality (64.7 ± 17.9 vs. 59.6 ± 17.3, p = 0.001), as well as significantly higher summary scores: physical component score (80.7 ± 18.2 vs. 78 ± 18.6, p = 0.042), and mental component score (79 ± 16.4 vs. 77.2 ± 15, p = 0.02). These results did not change after adjusting for social-demographic characteristics, health-related habits, and chronic diseases. Conclusions No significant difference between the groups was found in the prevalence of most chronic diseases, except for higher rates of skin nevi and NIRD among Dead Sea residents. HRQOL was significantly higher among Dead Sea residents, both healthy or with chronic disease.

Acute kidney injury (AKI) is a common complication following acute myocardial infarction (AMI) and associated with worse outcomes. Serum Potassium levels (K, mEq/L), which are regulated by the kidneys, are related with poor prognosis in patients with AMI. To evaluate whether K levels predict imminent AKI in patients with AMI. This retrospective nested case-control study was based on medical records of hospitalized AMI patients, 2002–2012. The cases (AKI group) were defined as an increase of ≥1.5-fold in serum creatinine level or a decrease of ≥25% in the estimated glomerular filtration rate (eGFR) during the hospitalization. The control group comprised of matched randomly selected patients that did not develop AKI. For both groups, all creatinine and K levels were obtained for up-to 72 h prior to the AKI diagnosis (index time). A total of 12,498/17,678 admissions met the inclusion criteria. The AKI and the control groups consisted of 430 and 1345 matched admission respectively. K levels, prior AKI diagnosis seemed to be higher in the AKI group. Multivariate analysis showed that K ≥ 4.5 within 36–56 h prior to the index time was an independent predictor of the subsequent AKI, OR = 2.3, p <.001. The c-statistic of the model was 0.859, p <.001. Predictivity of K for AKI was stronger among ST-elevation (STEMI) vs. Non-ST-elevation AMI (NSTEMI) patients (OR = 4, p <.001 vs. 1.7, p =.025 respectively; p-for-interaction = 0.038). K ≥ 4.5 is an independent and incremental marker of imminent AKI in patients with AMI, predictivity is stronger in patients with STEMI than NSTEMI. • Acute kidney injury (AKI) is a common complication of myocardial infarction (MI) • High K independently predict imminent AKI within the time window of 36–56 h • The study presents a simple and accurate model for prediction AKI after MI [ABSTRACT FROM AUTHOR]

Patients with new-onset of atrial fibrillation (NOAF) during acute myocardial infarction (AMI) currently receive long-term oral anticoagulation. The risk for stroke of "early" versus "late" onset of atrial fibrillation (AF) has not been elucidated. Consecutively, AMI patients admitted to a tertiary medical center were analyzed. We excluded patients with preexisting AF, AMI onset ≥24 hours prior to admission, significant valvular disease, fever >38.5°C, in-hospital death, or coronary artery bypass graft. Atrial fibrillation was verified by electrocardiography and medical records. Overall 7061 patients were included, 1.4% developed "early-paroxysmal AF (PAF)" that resolved within 24 hours of admission and 2.5% had "late-AF" beyond the first 24 hours. Median follow-up was ≈6 years. Primary end points included ischemic stroke and all-cause mortality. Stroke rates were higher only in patients with late-AF versus no-AF but not in the early-PAF: 10.6% versus 4.2%, 5.3%, respectively (P <.001). Death rates were higher in patients with late-AF and early-PAF versus no-AF: 55.3%, 43.2%, and 29.2%, respectively (P <.001). Congestive heart failure, hypertension, age ≥75, diabetes mellitus, a stroke or transient ischemic attack, vascular disease, age 65-74, female (CHA2DS2-VASc) score underestimated stroke risk in the late-AF group. In conclusion, the study generates the hypothesis that patients with early-PAF may not have a high stroke risk questioning the indication for long-term anticoagulation. [ABSTRACT FROM AUTHOR]

New-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI) has significant consequences but is often misdiagnosed. The aim of the study was to evaluate predictors of NOAF throughout different phases of AMI. Patients with AMI admitted to a tertiary medical center were analyzed. Exclusion criteria were preexisting AF, AMI onset ≥24 hours prior to admission, in-hospital death, significant valvular disease, and in-hospital coronary artery bypass graft. Study population were AMI without-NOAF, early-AF (AF terminated within 24 hours of admission), and late-AF (beyond the first 24 hours). Overall 5946 patients were included, age: 64.8 ±14.8 years; 30% women. The incidence of NOAF was 4.6%: 1.6% early-AF, and 3% late-AF. Patients with NOAF comprised greater rate of women, cardiovascular risk-factors burden, severe left ventricular-dysfunction, pulmonary hypertension, valvular disorders, and left atrial enlargement compared with patients without-NOAF. Non-ST-elevation myocardial infarction and inferior-ST-elevation myocardial infarction (STEMI) were significantly more prevalent among early-AF group, while anterior-STEMI, in late-AF. The final multivariate models showed c-statistics of 0.73 and 0.76 for the prediction of new-onset early-AF and late-AF, respectively. In conclusion, there are different clinical predictors of early- versus late-NOAF. The study points out "high risk" AMI population for more meticulous heart rate monitoring for NOAF. [ABSTRACT FROM AUTHOR]

Acute myocardial infarction (AMI) is associated with significant systemic metabolic changes. These changes include increased plasma concentrations of counter-regulatory hormones and changes in potassium (K, mEq/L) and glucose (mg/dL) levels. The latter are associated with outcomes and investigated as potential focus for intervention; glucose-insulin‑potassium (GIK) solution. To evaluate the associations of concomitant K and glucose (K/glucose) levels with in-hospital mortality in AMI patients. AMI patients hospitalized in a tertiary Medical Center through 2002–2012 were studied. K/glucose levels were divided into equally sized categories. The intermediate category (glucose 124–143 mg/dL, K 4–4.9 mEq/L) was the reference group. The associations of these tests with the outcome were assessed using Generalized Estimating Equations model which included the interaction of K and glucose levels, adjusted for the patient's baseline characteristics and other laboratory results. 17,670 AMI admissions (mean age 67.8 ± 4.0 years, 66.6% males, mortality rate 7.7%) were included; 112,531 results of K/glucose tests were recorded. Univariate and multivariate analyses showed that K/glucose levels were significantly associated with in-hospital mortality, with highest risk being in patients with concomitant low K (<3.7 mEq/L) and high glucose (≥217 mg/dL), adjOR = 2.53. It seems that low-normal glucose levels attenuate the increased risk associated with low K. The highest independent risk for mortality is found with low K and concomitant high glucose levels. Additional studies evaluating mechanisms and therapeutic interventions in K/glucose levels in this setting are warranted. • Associations of plasma potassium and glucose levels with outcomes in AMI are investigated as potential focus for intervention. • Combined potassium and glucose levels are associated with in-hospital mortality in AMI patients. • The highest independent risk for mortality is associated with the combination of low potassium and high glucose levels. [ABSTRACT FROM AUTHOR]

Cardiovascular (CV) patients are becoming older with a greater number of CV risk factors (CVRFs). The Framingham risk score (FRS) includes the major CVRFs and is used for CV risk stratification. We investigated temporal trends in burden of CVRFs among patients with acute myocardial infarction (AMI) throughout a decade. Patients with AMI hospitalized through 2002 to 2012 were studied. The baseline characteristics included age, sex, ethnicity, type of AMI (ST-segment elevation [STEMI] vs non-STEMI [NSTEMI]), coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, hypertension, obesity, smoking, and blood lipid profile. The FRS was calculated for each patient. A total of 14 698 AMI admissions were included (age 66.9 ± 13.6 years, 68% males, 47.6% STEMI). Half of admitted cases had ≥4 CVRFs. The mean FRS was 17.1 ± 4.1. Throughout the study period, patients with AMI became older with increased burden of CVRFs. The mean FRS increased from 16.8 ± 4.0 (2002) to 17.3 ± 4.1 (2012; P <.001). Multivariate analysis demonstrated a significant increase in FRS among patients with NSTEMI and significant decrease for patients with STEMI. Conclusions: The last decade, patients with AMI became older with increased burden of CVRFs. Framingham risk score increased among patients with NSTEMI and decreased in patients with STEMI. These trends impact on risk stratification and secondary prevention programs. [ABSTRACT FROM AUTHOR]

Objective: Acute myocardial infarction (AMI) is associated with significant risk for long-term morbidity and healthcare expenditure. We investigated healthcare utilization and direct costs throughout 10 years following AMI. Methods: A retrospective study included AMI patients hospitalized in a tertiary medical center throughout 2002-2012. Data was obtained from computerized medical records. Hospitalizations, emergency department (ED), primary care and outpatient consulting clinic visits and other ambulatory services, following the AMI and their costs, were compared with the year preceding the AMI. Results: Overall 9548 patients were analyzed (age 66.6 ± 13.9 years, 67.8% men, 48.1% ST-elevation AMI). A significant increase in the utilization of all the evaluated services was observed in the first year following the AMI compared with the preceding year (p < .001 for each) and followed by a decline thereafter (p-for trend < .001 for each) except increased number of ED visits (p-for trend = .014). Annual per-patient costs throughout the first year following AMI (5592€) were significantly greater compared with the preceding year (3120€) and declined subsequently to 3216€ and 2760€ for years 2-5 and 6-10, respectively. Multivariate analysis showed that throughout the first half of the follow-up total costs were slightly higher and in the second half similar to the year preceding the AMI. Analysis of the relative costs showed that ambulatory services make up most of the expenditure. Conclusions: Healthcare utilization and economic expenditure peak throughout the first year and decline afterwards. For several services it remains higher for up to 10 years compared with the year preceding the AMI. [ABSTRACT FROM AUTHOR]

Background: Decisions on dual antiplatelet therapy (DAPT) duration should balance the opposing risks of ischaemia and bleeding. Our aim was to develop a risk score to identify stable coronary artery disease (SCAD) patients undergoing PCI who would benefit or suffer from extending DAPT beyond 6 months. Methods: Retrospective analysis of a cohort of patients who completed 6 months of DAPT following PCI. Predictors of ischaemic and bleeding events for the 6–12 month period post-PCI were identified and a risk score was developed to estimate the likelihood of benefiting from extending DAPT beyond 6 months. Incidence of mortality, ischaemic and bleeding events for patients treated with DAPT for 6 vs. 6–12 months, was compared, stratified by strata of the risk score. Results: The study included 2,699 patients. Over 6 months’ follow up, there were 78 (2.9%) ischaemic and 43 (1.6%) bleeding events. Four variables (heart failure, left ventricular ejection fraction ≤30%, left main or three vessel CAD, status post (s/p) PCI and s/p stroke) predicted ischemic events, two variables (age>75, haemoglobin <10 g/dL) predicted bleeding. In the lower stratum of the risk score, 6–12 months of treatment with DAPT resulted in increased bleeding (p = 0.045) with no decrease in ischaemic events. In the upper stratum, 6–12 months DAPT was associated with reduced ischaemic events (p = 0.029), with no increase in bleeding. Conclusion: In a population of SCAD patients who completed 6 months of DAPT, a risk score for subsequent ischaemic and bleeding events identified patients likely to benefit from continuing or stopping DAPT. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]