Ahmet ÖZ, Tufan ÇINAR, Mehmet Baran KARATAŞ, Ali Nazmi ÇALIK, Kazım Serhan ÖZCAN, Yiğit ÇANGA, Osman BOLCA, Ömer KOZAN

ST-YÜKSELMELİ MİYOKARD ENFARKTÜSÜ (STYME) HASTALARINDA HASTANE İÇİ MAJÖR KARDİYAK OLAYLARIN ÖNGÖRDÜRÜCÜSÜ: SERUM POTASYUM DÜZEYLERİNDEKİ DEĞİŞKENLİK ORANI

Amaç: Potasyumun (K+) kardiyovasküler hastalıklardaki kritik rolü ve olumsuz kardiyak olayları önlemede normokalemik durumu devam ettirmenin önemi her geçen gün daha iyi anlaşılmaktadır. Çalışmamızda, normal sınırlar içerisinde olmasına rağmen, serum potasyum düzeylerindeki değişkenlik oranı ile ST-yükselmeli miyokard enfarktüsü (STyME) hastalarında izlenen hastane içi majör kardiyak olaylar (MACE) arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntemler: 2013 – 2015 yılları arasında tersiyer merkezimize STyME tanısı ile başvuran toplam 419 hasta retrospektif olarak dizayn edilen çalışmamıza dahil edildi. Hastaneye başvuru anında veya hastane içi takipleri sırasında normal değerlerin dışında K+ düzeyi saptanan hastalar çalışmaya alınmaz iken, hastane yatışı boyunca en az 5 (beş) ardışık K+ değeri mevcut olan hastalar çalışmaya dahil edildi. Bulgular: Çok değişkenli regresyon analizinde, çalışma populasyonundaki serum K+ düzeylerinin değişkenlik oranı (OR: 7.84, 95%CI: 1.18-51.81, p=0.03) hastane içi olumsuz kardiyak olayların (MACE) bağımsız öngördürücüsü olarak saptandı. Serum K+ düzeylerinin değişkenlik oranı ≥ 0.57 (optimal kestirim değeri) olması halinde, hastane içi olumsuz olayları % 46.2 duyarlılık ve % 84.9 özgüllükle öngörmekteydi. [area under curve (AUC) 0.66, p=0.001]. Sonuç: Çalışmamızın sonuçları, normal sınırlar içinde olsa dahi değişkenlik gösteren K+ düzeylerinin STyME hastalarında hastane içi olumsuz olayların bağımsız bir öngördürücüsü olabileceğini göstermiştir. Bu nedenle, artmış oranda K+ düzeyi değişkenliği gösteren hastaların daha yakından takibi olumsuz kardiyak olayları en aza indirmek açısından büyük önem arz etmektedir.

Variability Rate of Serum Potassium Levels Predicts Inhospital Major Adverse Cardiac Events in Patients with STElevation Myocardial Infarction (STEMI)

Objective: The critical role of potassium (K+) in cardiovascular disease and, maintaining a normokalemicstate are increasingly being recognized to preclude adverse cardiac events. The main objective of our studywas to evaluate whether there is an association between the variability of serum potassium levels, evenwithin the normal range, and in-hospital major adverse cardiovascular events (MACE) in patients with STelevation myocardial infarction (STEMI).Materials and Method: A total of 419 patients who were admitted to our tertiary heart center with a diagnosis of STEMI from May 2013 to May 2015 were included in this retrospective study. The patients whohave any serum K+ levels beyond the normal range on admission and during the in-hospital follow-up interval were excluded. The patients who had at least five consecutive serum K+ measurements during thein-hospital stay were included in the study.Results: In multivariable logistic regression analysis, the variability of serum K+ levels (OR: 7.84, 95%CI: 1.18-51.81, p=0.03) was found to be independently associated with MACE in the study population. The optimalcut-off value of the variability of serum K+ levels was ≥ 0.57 with a sensitivity of 46.2% and a specificity of84.9% [area under curve (AUC) 0.66, p=0.001].Conclusion: Our findings provide evidence that variability of serum K+ levels even within the normal rangemay be an independent predictor of MACE in STEMI patients. Therefore, close follow up of the patients witha high variability of serum K+ levels has utmost importance in order to minimize the risk of MACE.

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