International journal of cardiology · 2018
Potassium levels and risk of in-hospital arrhythmias and mortality in patients admitted with suspected acute coronary syndrome.
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Faxén Jonas, Xu Hong, Evans Marie, Jernberg Tomas, Szummer Karolina, Carrero Juan-Jesus
Аннотация
BACKGROUND: In acute coronary syndrome (ACS), potassium imbalance at admission has been associated with in-hospital arrhythmias, cardiac arrest, and mortality. However, several important presentation characteristics and subtype of ACS have not been considered.
METHODS: Consecutive patients (n = 32,955) admitted with suspected ACS between 2006 and 2011, registered in the Swedish Web-System for Enhancement and Development of Evidence-Based care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) and the Stockholm CREAtinine Measurements (SCREAM) project were included. Associations between admission plasma potassium categories (reference 3.5-<4.0 mmol/L) and in-hospital outcomes including mortality, cardiac arrest, new-onset atrial fibrillation, and second- or third-degree atrioventricular block were assessed with logistic regression models. Covariates included demographics, presentation characteristics, comorbidities, estimated glomerular filtration rate (eGFR), main diagnosis, and medication on admission.
RESULTS: U-shaped associations between admission potassium, mortality and cardiac arrest were observed. However, in fully adjusted models, only hyperkalemia (5.0-<5.5 [OR 1.83; 95% CI, 1.34-2.49] and ≥5.5 mmol/L [OR 2.27; 95% CI, 1.57-3.27]) was associated with mortality, while only hypokalemia (3.0-<3.5 [OR 1.63; 95% CI, 1.21-2.19] and <3.0 mmol/L [OR 2.72; 95% CI, 1.56-4.74]) was associated with cardiac arrest. Potassium <3.0 mmol/L (OR 1.93; 95% CI, 1.00-3.76) was associated with new-onset atrial fibrillation. After multivariable adjustment, no association was observed between potassium and second- or third-degree atrioventricular block. Results were not modified by main diagnosis (ACS subtype or non-ACS diagnosis) or eGFR.
CONCLUSIONS: Hyperkalemia at admission is associated with in-hospital mortality and hypokalemia with cardiac arrest and new-onset atrial fibrillation in patients admitted with suspected ACS.
METHODS: Consecutive patients (n = 32,955) admitted with suspected ACS between 2006 and 2011, registered in the Swedish Web-System for Enhancement and Development of Evidence-Based care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) and the Stockholm CREAtinine Measurements (SCREAM) project were included. Associations between admission plasma potassium categories (reference 3.5-<4.0 mmol/L) and in-hospital outcomes including mortality, cardiac arrest, new-onset atrial fibrillation, and second- or third-degree atrioventricular block were assessed with logistic regression models. Covariates included demographics, presentation characteristics, comorbidities, estimated glomerular filtration rate (eGFR), main diagnosis, and medication on admission.
RESULTS: U-shaped associations between admission potassium, mortality and cardiac arrest were observed. However, in fully adjusted models, only hyperkalemia (5.0-<5.5 [OR 1.83; 95% CI, 1.34-2.49] and ≥5.5 mmol/L [OR 2.27; 95% CI, 1.57-3.27]) was associated with mortality, while only hypokalemia (3.0-<3.5 [OR 1.63; 95% CI, 1.21-2.19] and <3.0 mmol/L [OR 2.72; 95% CI, 1.56-4.74]) was associated with cardiac arrest. Potassium <3.0 mmol/L (OR 1.93; 95% CI, 1.00-3.76) was associated with new-onset atrial fibrillation. After multivariable adjustment, no association was observed between potassium and second- or third-degree atrioventricular block. Results were not modified by main diagnosis (ACS subtype or non-ACS diagnosis) or eGFR.
CONCLUSIONS: Hyperkalemia at admission is associated with in-hospital mortality and hypokalemia with cardiac arrest and new-onset atrial fibrillation in patients admitted with suspected ACS.