Journal Home > Volume 18 , Issue 1
BACKGROUND

The variability of metabolic biomarkers has been determined to provide incremental prognosis information, but the implications of electrolyte variability remained unclear.

METHODS

We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction (n = 4386). Ion variability was calculated as the coefficient of variation, standard deviation, variability independent of the mean (VIM) and range. Hazard ratios (HR) were estimated using the multivariable-adjusted Cox proportional regression method.

RESULTS

During a median follow-up of 12 months, 161 (3.7%) patients died, and heart failure occurred in 550 (12.5%) participants after discharge, respectively. Compared with the bottom quartile, the highest quartile potassium VIM was associated with increased risks of all-cause mortality (HR = 2.35, 95% CI: 1.36–4.06) and heart failure (HR = 1.32, 95% CI: 1.01–1.72) independent of cardiac troponin I (cTnI), N terminal pro B type natriuretic peptide (NT-proBNP), infarction site, mean potassium and other traditional factors, while those associations across sodium VIM quartiles were insignificant. Similar trend remains across the strata of variability by other three indices. These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.

CONCLUSIONS

Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction. Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.


menu
Abstract
Full text
Outline
Electronic supplementary material
About this article

Potassium variability during hospitalization and outcomes after discharge in patients with acute myocardial infarction

Show Author's information Xi-Ling ZHANG1,2,*Heng-Xuan CAI1,2,*Shan-Jie WANG1,2Xiao-Yuan ZHANG1,2Xin-Ran HAO2,3Shao-Hong FANG1,2Xue-Qin GAO1,2( )Bo YU1,2( )
Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, 246 Xuefu Road, Nangang District, Harbin, China
Department of Neurobiology, Neurobiology Key Laboratory, Harbin Medical University, Education Department of Heilongjiang Province, Harbin, China

*The authors contributed equally to this manuscript

Abstract

BACKGROUND

The variability of metabolic biomarkers has been determined to provide incremental prognosis information, but the implications of electrolyte variability remained unclear.

METHODS

We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction (n = 4386). Ion variability was calculated as the coefficient of variation, standard deviation, variability independent of the mean (VIM) and range. Hazard ratios (HR) were estimated using the multivariable-adjusted Cox proportional regression method.

RESULTS

During a median follow-up of 12 months, 161 (3.7%) patients died, and heart failure occurred in 550 (12.5%) participants after discharge, respectively. Compared with the bottom quartile, the highest quartile potassium VIM was associated with increased risks of all-cause mortality (HR = 2.35, 95% CI: 1.36–4.06) and heart failure (HR = 1.32, 95% CI: 1.01–1.72) independent of cardiac troponin I (cTnI), N terminal pro B type natriuretic peptide (NT-proBNP), infarction site, mean potassium and other traditional factors, while those associations across sodium VIM quartiles were insignificant. Similar trend remains across the strata of variability by other three indices. These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.

CONCLUSIONS

Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction. Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.

References(30)

[1]

Mcdonough AA, Youn JH. Potassium homeostasis: the knowns, the unknowns, and the health benefits. Physiology (Bethesda) 2017; 32: 100−111.

[2]

Reynolds RM, Padfield PL, Seckl JR. Disorders of sodium balance. BMJ 2006; 332: 702−705.

[3]

Macdonald JE, Struthers AD. What is the optimal serum potassium level in cardiovascular patients? J Am Coll Cardiol 2004; 43: 155−161.

[4]

Adrogue H J, Madias N E. Hyponatremia. N Engl J Med 2000; 342: 1581−1589.

[5]

Patel R B, Tannenbaum S, Viana-Tejedor A, et al. Serum potassium levels, cardiac arrhythmias, and mortality following non-ST-elevation myocardial infarction or unstable angina: insights from MERLIN-TIMI 36. Eur Heart J Acute Cardiovasc Care 2017; 6: 18−25.

[6]

Aronson D, Darawsha W, Promyslovsky M, et al. Hyponatraemia predicts the acute (type 1) cardio-renal syndrome. Eur J Heart Fail 2014; 16: 49−55.

[7]

Goyal A, Spertus J A, Gosch K, et al. Serum potassium levels and mortality in acute myocardial infarction. JAMA 2012; 307: 157−164.

[8]

Aldahl M, Jensen AC, Davidsen L, et al. Associations of serum potassium levels with mortality in chronic heart failure patients. Eur Heart J 2017; 38: 2890−2896.

[9]

Nunez J, Bayes-Genis A, Zannad F, et al. Long-term potassium monitoring and dynamics in heart failure and risk of mortality. Circulation 2018; 137: 1320−1330.

[10]

Burkhardt K, Kirchberger I, Heier M, et al. Hyponatraemia on admission to hospital is associated with increased long-term risk of mortality in survivors of myocardial infarction. Eur J Prev Cardiol 2015; 22: 1419−1426.

[11]

Grodzinsky A, Goyal A, Gosch K, et al. Prevalence and prognosis of hyperkalemia in patients with acute myocardial infarction. Am J Med 2016; 129: 858−865.

[12]

Plakht Y, Gilutz H, Shiyovich A. Sodium levels during hospitalization with acute myocardial infarction are markers of in-hospital mortality: Soroka acute myocardial infarction II (SAMI-II) project. Clin Res Cardiol 2018; 107: 956−964.

[13]

Yoo JE, Shin DW, Han K, et al. Blood pressure variability and the risk of dementia: a nationwide cohort Study. Hypertension 2020; 75: 982−990.

[14]

Stevens S L, Wood S, Koshiaris C, et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ 2016; 354: i4098.

[15]

Huikuri HV, Stein PK. Heart rate variability in risk stratification of cardiac patients. Prog Cardiovasc Dis 2013; 56: 153−159.

[16]

Hong SH, Lee JS, Kim JA, et al. Gamma-glutamyl transferase variability and the risk of hospitalisation for heart failure. Heart 2020; 106: 1080−1086.

[17]

Sheng C S, Tian J, Miao Y, et al. Prognostic significance of long-term HbA1c variability for all-cause mortality in the ACCORD trial. Diabetes Care 2020; 43: 1185−1190.

[18]

Kim M K, Han K, Park Y M, et al. Associations of variability in blood pressure, glucose and cholesterol concentrations, and body mass index with mortality and cardiovascular outcomes in the general population. Circulation 2018; 138: 2627−2637.

[19]

Bhambhani V, Kizer J R, Lima J, et al. Predictors and outcomes of heart failure with mid-range ejection fraction. Eur J Heart Fail 2018; 20: 651−659.

[20]

Wang S, Duan Y, Feng X, et al. Sustained nicorandil administration reduces the infarct size in ST-segment elevation myocardial infarction patients with primary percutaneous coronary intervention. Anatol J Cardiol 2019; 21: 163−171.

[21]

O’Donnell M J, Yusuf S, Mente A, et al. Urinary sodium and potassium excretion and risk of cardiovascular events. JAMA 2011; 306: 2229−2238.

[22]

Qureshi W, Hassan S, Khalid F, et al. Outcomes of correcting hyponatremia in patients with myocardial infarction. Clin Res Cardiol 2013; 102: 637−644.

[23]

Testani J M, Hanberg J S, Arroyo J P, et al. Hypochloraemia is strongly and independently associated with mortality in patients with chronic heart failure. Eur J Heart Fail 2016; 18: 660−668.

[24]

Xi H, Yu R H, Wang N, et al. Serum potassium levels and mortality of patients with acute myocardial infarction: A systematic review and meta-analysis of cohort studies. Eur J Prev Cardiol 2019; 26: 145−156.

[25]

Colombo M G, Kirchberger I, Amann U, et al. Association of serum potassium concentration with mortality and ventricular arrhythmias in patients with acute myocardial infarction: A systematic review and meta-analysis. Eur J Prev Cardiol 2018; 25: 576−595.

[26]

Choi J S, Kim Y A, Kim H Y, et al. Relation of serum potassium level to long-term outcomes in patients with acute myocardial infarction. Am J Cardiol 2014; 113: 1285−1290.

[27]

Xu H, Faxen J, Szummer K, et al. Dyskalemias and adverse events associated with discharge potassium in acute myocardial infarction. Am Heart J 2018; 205: 53−62.

[28]

Rastogi A, Novak E, Platts A E, et al. Epidemiology, pathophysiology and clinical outcomes for heart failure patients with a mid-range ejection fraction. Eur J Heart Fail 2017; 19: 1597−1605.

[29]

Desta L, Jernberg T, Spaak J, et al. Heart failure with normal ejection fraction is uncommon in acute myocardial infarction settings but associated with poor outcomes: a study of 91,360 patients admitted with index myocardial infarction between 1998 and 2010. Eur J Heart Fail 2016; 18: 46−53.

[30]

Kraft M D, Btaiche I F, Sacks G S, et al. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm 2005; 62: 1663−1682.

File
20200930002-ESM.pdf (5.8 MB)
Publication history
Copyright
Acknowledgements
Rights and permissions

Publication history

Published: 28 January 2021
Issue date: January 2021

Copyright

© 2021 JGC All rights reserved

Acknowledgements

ACKNOWLEDGEMENTS

We would like to thank the staff of cardiac follow-up team for raw data collecting.

Rights and permissions

Return