Prevalence and Prognosis of Hyperkalemia in Patients with Acute Myocardial Infarction - 25/07/16
, Abhinav Goyal, MD, MHS c, Kensey Gosch, MS a, Peter A. McCullough, MD, MPH d, e, Gregg C. Fonarow, MD f, Alexandre Mebazaa, MD g, Frederick A. Masoudi, MD, MSPH h, John A. Spertus, MD, MPH a, b, Biff F. Palmer, MD i, Mikhail Kosiborod, MD a, bAbstract |
Background |
Hyperkalemia is common and potentially dangerous in hospitalized patients; its contemporary prevalence and prognostic importance after acute myocardial infarction are not well described.
Methods |
In 38,689 consecutive patients with acute myocardial infarction from the Cerner Health Facts database, we evaluated the association between maximum in-hospital potassium levels and in-hospital mortality. Patients were stratified by dialysis status and grouped by maximum potassium as follows: <5 mEq/L, 5 to <5.5 mEq/L, 5.5 to <6.0 mEq/L, 6.0 to <6.5 mEq/L, and ≥6.5 mEq/L. Multivariable logistic regression was used to adjust for multiple patient and site characteristics. The relationship between the number of hyperkalemic values and the in-hospital mortality was evaluated.
Results |
Of 38,689 patients with acute myocardial infarction, 886 were on dialysis. The rate of hyperkalemia (maximum potassium ≥5.0 mEq/L) was 22.6% in patients on dialysis and 66.8% in patients not on dialysis. Moderate to severe hyperkalemia (maximum potassium ≥5.5 mEq/L) occurred in 9.8% of patients. There was a steep increase in mortality with higher maximum potassium levels. In-hospital mortality exceeded 15% once maximum potassium was ≥5.5 mEq/L regardless of dialysis status. The relationship between higher maximum potassium and increased mortality risk persisted after multivariable adjustment. In addition, patients with a greater number of hyperkalemic values (vs a single value) experienced higher in-hospital mortality.
Conclusions |
Hyperkalemia is common in patients who are hospitalized with acute myocardial infarction. Higher maximum potassium levels and number of hyperkalemic events are associated with a steep mortality increase, with higher risks for adverse outcomes observed even at mild levels of hyperkalemia. Whether more intensive management of hyperkalemia may improve outcomes in patients with acute myocardial infarction merits further study.
Le texte complet de cet article est disponible en PDF.Keywords : Acute myocardial infarction, Dialysis, Hyperkalemia prevalence
Plan
| Funding: AG is supported by a T32 training grant from the National Heart, Lung, and Blood Institute (T32HL110837). The funding agencies had no role in the data collection, analysis, interpretation, or decision to submit the results. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. |
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| Conflict of Interest: AM reports speaker's honoraria from The Medicines Company, Novartis, Orion, Roche, Servier, and Vifor Pharma, and fees as a member of the advisory board or Steering Committee from Cardiorentis, The Medicines Company, Adrenomed, MyCartis, ZS Pharma, and Critical Diagnostics. JAS reports research grants from Lilly, Abbott Vascular, and Genentech, and consulting work for United Healthcare, Amgen, Novartis, and Janssen. MK reports consulting fees from AbbVie, AstraZeneca, Edwards Life Sciences, Gilead Sciences, Roche, St Jude Medical, Genentech, Regeneron, Lilly, and ZS Pharma, and speaker fees from the American Association of Clinical Endocrinology, American Diabetes Association, Curators of the University of Missouri, Washington Medical Center, HealthSciences Media, Inc, Heartland Mid-America Chapter of American Association of Clinical Endocrinologists, and R & R Healthcare Communications, Inc. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 129 - N° 8
P. 858-865 - août 2016 Retour au numéro
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