Research on the Correlation between Admission Serum Potassium Level and Long-term Prognosis in Patients with Unstable Angina_West China Medical Journal

Authors：

 LuoYang , HuangFangyang , PengYong , XiaTianli , HuangBaotao ,  ChenMao

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ChenMao, Email: hmaochen@vip.sina.com

Keywords：

Unstable angina; Serum potassium level; Long-term prognosis

DOI：

10.7507/1002-0179.201600125

Video：

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Objective To investigate the relationship between admission serum potassium level and long-term prognosis in patients with unstable angina. Methods We studied the data of 1 412 patients with unstable angina who received coronary angiography examinations and completed the follow-up between July 2008 and September 2012. Serum potassium level within the first 24 hours after admission was collected. According to the serum potassium level, the patients were divided into three groups:those with a serum potassium level lower than 3.5 mmol/L, those with a level between 3.5 and 5.0 mmol/L and those with a level higher than 5.0 mmol/L. Then, we analyzed the relationship between admission serum potassium level and long-term prognosis in patients with unstable angina. Results There was a U-shaped relationship between admission serum potassium level and long-term mortality that persisted after multivariable adjustment in patients with unstable angina. The all-cause mortality risk was the lowest in the group of patients with a potassium level of 3.5 to 5.0 mmol/L, whereas mortality was higher in patients with potassium level lower than 3.5 mmol/L and higher than 5.0 mmol/L [HR=1.89, 95%CI (1.13, 3.17), P=0.016; HR=1.64, 95%CI (0.40, 6.77), P=0.493]. Compared with patients with a serum potassium level between 3.5 and 5.0 mmol/L, the cardiovascular mortality risk was significantly higher in those patients with a potassium level lower than 3.5 mmol/L [HR=1.99, 95%CI (1.01, 3.94), P=0.048]. Conclusion There is a U-shaped relationship between admission serum potassium level and long-term all-cause mortality rate, and the all-cause mortality rate and cardiovascular mortality risk was the lowest in patients with a potassium level between 3.5 and 5.0 mmol/L.

Citation： LuoYang, HuangFangyang, PengYong, XiaTianli, HuangBaotao, ChenMao. Research on the Correlation between Admission Serum Potassium Level and Long-term Prognosis in Patients with Unstable Angina. West China Medical Journal, 2016, 31(3): 458-462. doi: 10.7507/1002-0179.201600125 Copy

1.	Kafka H, Langevin L, Armstrong PW. Serum magnesium and potassium in acute myocardial infarction. Influence on ventricular arrhythmias[J]. Arch Intern Med, 1987, 147(3):465-469.
2.	Dyckner T, Helmers C, Lundman T, et al. Initial serum potassium level in relation to early complications and prognosis in patients with acute myocardial infarction[J]. Acta Med Scand, 1975, 197(3):207-210.
3.	Salerno DM, Asinger RW, Elsperger J, et al. Frequency of hypokalemia after successfully resuscitated out-of-hospital cardiac arrest compared with that in transmural acute myocardial infarction[J]. Am J Cardiol, 1987, 59(1):84-88.
4.	Cooper HA, Dries DL, Davis CE, et al. Diuretics and risk of arrhythmic death in patients with left ventricular dysfunction[J]. Circulation, 1999, 100(12):1311-1315.
5.	Gennari FJ. Hypokalemia[J]. N Engl J Med, 1998, 339(7):451-458.
6.	Madias JE, Shah B, Chintalapally G, et al. Admission serum potassium in patients with acute myocardial infarction:its correlates and value as a determinant of in-hospital outcome[J]. Chest, 2000, 118(4):904-913.
7.	Friedensohn A, Faibel HE, Bairey O, et al. Malignant arrhythmias in relation to values of serum potassium in patients with acute myocardial infarction[J]. Int J Cardiol, 1991, 32(3):331-338.
8.	Macdonald JE, Struthers AD. What is the optimal serum potassium level in cardiovascular patients?[J]. J Am Coll Cardiol, 2004, 43(2):155-161.
9.	Gettes L, Surawicz B. Effects of low and high concentrations of potassium on the simultaneously recorded Purkinje and ventricular action potentials of the perfused pig moderator band[J]. Circ Res, 1968, 23(6):717-729.
10.	Fisch C, Knoebel SB, Feigenbaum H, et al. Potassium and the monophasic action potential, electrocardiogram, conduction and arrhythmias[J]. Prog Cardiovasc Dis, 1966, 8(5):387-418.
11.	汪晶晶, 卢喜烈, 陈韵岱. 电风暴患者临床特点和病因分析[J]. 中华保健医学杂志, 2013, (3):216-218.
12.	华琦, 李东宝. 低钾血症对急性心肌梗死患者预后的影响[J]. 中华老年心脑血管病杂志, 2006(9):582-584.
13.	Weiner ID, Wingo CS. Hyperkalemia:a potential silent killer[J]. J Am Soc Nephrol, 1998, 9(8):1535-1543.
14.	Weisberg LS, Szerlip HM, Cox M. Disorders of potassium homeostasis in critically ill patients[J]. Crit Care Clin, 1987, 3(4):835-854.
15.	Jensen HK, Brabrand M, Vinholt PJ, et al. Hypokalemia in acute medical patients:risk factors and prognosis[J]. Am J Med, 2015, 128(1):60-67.e1.
16.	Anderson JL, Adams CD, Antman EM, et al. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 2011, 123(18):e426-e579.
17.	Choi JS, Kim YA, Kim HY, et al. Relation of serum potassium level to long-term outcomes in patients with acute myocardial infarction[J]. Am J Cardiol, 2014, 113(8):1285-1290.
18.	Shiyovich A, Gilutz H, Plakht Y. Serum potassium levels and long-term post-discharge mortality in acute myocardial infarction[J]. Int J Cardiol, 2014, 172(2):e368-e370.
19.	Goyal A, Spertus JA, Gosch K, et al. Serum potassium levels and mortality in acute myocardial infarction[J]. JAMA, 2012, 307(2):157-164.

1. Kafka H, Langevin L, Armstrong PW. Serum magnesium and potassium in acute myocardial infarction. Influence on ventricular arrhythmias[J]. Arch Intern Med, 1987, 147(3):465-469.
2. Dyckner T, Helmers C, Lundman T, et al. Initial serum potassium level in relation to early complications and prognosis in patients with acute myocardial infarction[J]. Acta Med Scand, 1975, 197(3):207-210.
3. Salerno DM, Asinger RW, Elsperger J, et al. Frequency of hypokalemia after successfully resuscitated out-of-hospital cardiac arrest compared with that in transmural acute myocardial infarction[J]. Am J Cardiol, 1987, 59(1):84-88.
4. Cooper HA, Dries DL, Davis CE, et al. Diuretics and risk of arrhythmic death in patients with left ventricular dysfunction[J]. Circulation, 1999, 100(12):1311-1315.
5. Gennari FJ. Hypokalemia[J]. N Engl J Med, 1998, 339(7):451-458.
6. Madias JE, Shah B, Chintalapally G, et al. Admission serum potassium in patients with acute myocardial infarction:its correlates and value as a determinant of in-hospital outcome[J]. Chest, 2000, 118(4):904-913.
7. Friedensohn A, Faibel HE, Bairey O, et al. Malignant arrhythmias in relation to values of serum potassium in patients with acute myocardial infarction[J]. Int J Cardiol, 1991, 32(3):331-338.
8. Macdonald JE, Struthers AD. What is the optimal serum potassium level in cardiovascular patients?[J]. J Am Coll Cardiol, 2004, 43(2):155-161.
9. Gettes L, Surawicz B. Effects of low and high concentrations of potassium on the simultaneously recorded Purkinje and ventricular action potentials of the perfused pig moderator band[J]. Circ Res, 1968, 23(6):717-729.
10. Fisch C, Knoebel SB, Feigenbaum H, et al. Potassium and the monophasic action potential, electrocardiogram, conduction and arrhythmias[J]. Prog Cardiovasc Dis, 1966, 8(5):387-418.
11. 汪晶晶, 卢喜烈, 陈韵岱. 电风暴患者临床特点和病因分析[J]. 中华保健医学杂志, 2013, (3):216-218.
12. 华琦, 李东宝. 低钾血症对急性心肌梗死患者预后的影响[J]. 中华老年心脑血管病杂志, 2006(9):582-584.
13. Weiner ID, Wingo CS. Hyperkalemia:a potential silent killer[J]. J Am Soc Nephrol, 1998, 9(8):1535-1543.
14. Weisberg LS, Szerlip HM, Cox M. Disorders of potassium homeostasis in critically ill patients[J]. Crit Care Clin, 1987, 3(4):835-854.
15. Jensen HK, Brabrand M, Vinholt PJ, et al. Hypokalemia in acute medical patients:risk factors and prognosis[J]. Am J Med, 2015, 128(1):60-67.e1.
16. Anderson JL, Adams CD, Antman EM, et al. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 2011, 123(18):e426-e579.
17. Choi JS, Kim YA, Kim HY, et al. Relation of serum potassium level to long-term outcomes in patients with acute myocardial infarction[J]. Am J Cardiol, 2014, 113(8):1285-1290.
18. Shiyovich A, Gilutz H, Plakht Y. Serum potassium levels and long-term post-discharge mortality in acute myocardial infarction[J]. Int J Cardiol, 2014, 172(2):e368-e370.
19. Goyal A, Spertus JA, Gosch K, et al. Serum potassium levels and mortality in acute myocardial infarction[J]. JAMA, 2012, 307(2):157-164.

West China Medical Journal

Research on the Correlation between Admission Serum Potassium Level and Long-term Prognosis in Patients with Unstable Angina

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