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Dyskalemias and adverse events associated with discharge potassium in acute myocardial infarction.
- Source :
-
American heart journal [Am Heart J] 2018 Nov; Vol. 205, pp. 53-62. Date of Electronic Publication: 2018 Jun 22. - Publication Year :
- 2018
-
Abstract
- Background: The incidence of dyskalemias and associated outcomes in acute myocardial infarction (AMI) are unknown in real-world settings and likely differ from the controlled environment of randomized controlled trials.<br />Methods: We examined consecutive survivors of an AMI during 2006-2011 in SWEDEHEART registry and with plasma potassium at discharge (exposure). Study outcomes were 1-year risk of hyperkalemia (potassium >5.0 mmol/L), hypokalemia (potassium <3.5 mmol/L), and others (1-year risk of death, new myocardial infarction, heart failure, and de novo atrial fibrillation). Covariates included demographics, comorbidities, hospital procedures, and medications.<br />Results: We included 4,861 patients (65% male, age 71.4 ± 12.6 years) with mean discharge potassium of 4.0 ± 0.4 mmol/L. Within 1 year, 784 (16.1%) new hyperkalemic and 991 (20.4%) new hypokalemic events occurred. Discharge potassium and kidney dysfunction were independent predictors of their occurrence. Compared with discharge potassium of 4.0 to <4.5 mmol/L, the adjusted risk of incident hyperkalemia was 1.71 (95% confidence interval 1.41-2.06) for potassium of 4.5-5.0 mmol/L and 2.38 (1.69-3.35) for potassium of >5.0 mmol/L; the adjusted risk of incident hypokalemia was 1.43 for potassium of 3.5 to <4.0 mmol/L (1.23-1.66) and 3.12 (2.58-3.77) for potassium of <3.5 mmol/L. A U-shaped association was observed between discharge potassium and the risk of death (n = 718), with increased hazards for potassium <3.5 and >4.5 mmol/L. No association was found between discharge potassium and the risk of new myocardial infarction, heart failure, or de novo atrial fibrillation.<br />Conclusions: Among real-world AMI survivors, both hyperkalemia and hypokalemia are frequent. Discharge potassium and kidney function strongly predicted their occurrence, as well as the 1-year risk of death.<br /> (Copyright © 2018. Published by Elsevier Inc.)
- Subjects :
- Aged
Female
Follow-Up Studies
Humans
Hyperkalemia blood
Hyperkalemia epidemiology
Hypokalemia blood
Hypokalemia epidemiology
Incidence
Male
Myocardial Infarction blood
Myocardial Infarction epidemiology
Retrospective Studies
Risk Factors
Survival Rate trends
Sweden epidemiology
Hyperkalemia etiology
Hypokalemia etiology
Myocardial Infarction complications
Potassium blood
Registries
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6744
- Volume :
- 205
- Database :
- MEDLINE
- Journal :
- American heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 30170177
- Full Text :
- https://doi.org/10.1016/j.ahj.2018.06.009