ST-YÜKSELMELİ MİYOKARD ENFARKTÜSÜ (STYME) HASTALARINDA HASTANE İÇİ MAJÖR KARDİYAK OLAYLARIN ÖNGÖRDÜRÜCÜSÜ: SERUM POTASYUM DÜZEYLERİNDEKİ DEĞİŞKENLİK ORANI Variability Rate of Serum Potassium Levels Predicts Inhospital Major Adverse Cardiac Events in Patients with STElevation Myocardial Infarction (S
ÖZET
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.
Anahtar kelimeler: Potasyum; ST-yükselmeli miyokard enfarktüsü; Majör olumsuz kardiyak olaylar
ABSTRACT
Objective: The critical role of potassium (K+) in cardiovascular disease and, maintaining a normokalemic
state are increasingly being recognized to preclude adverse cardiac events. The main objective of our study
was to evaluate whether there is an association between the variability of serum potassium levels, even
within 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 who
have 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 the
in-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 optimal
cut-off value of the variability of serum K+ levels was ? 0.57 with a sensitivity of 46.2% and a specificity of
84.9% [area under curve (AUC) 0.66, p=0.001].
Conclusion: Our findings provide evidence that variability of serum K+ levels even within the normal range
may be an independent predictor of MACE in STEMI patients. Therefore, close follow up of the patients with
a high variability of serum K+ levels has utmost importance in order to minimize the risk of MACE.
Keywords: Potassium; ST-elevation myocardial infarction; Major adverse cardiovascular events
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- 1. Dixon DL, Abbate A. Potassium levels in acute myocardial infarction:
definitely worth paying attention to. Eur Heart J Cardiovasc
Pharmacother. 2015; 1:252-53.
2. Grumbach L, Howard JW,Merrill VI. Factors related to the initiation
of ventricular fibrillation in the isolated heart; effect of calcium
and potassium. Circ Res. 1954; 2:452-9.
3. Herlitz J, Hjalmarson A, Bengtson A. Occurrence of hypokalemia
in suspected acute myocardial infarction and its relation to clinical
history and clinical course. Clin Cardiol. 1988;11:678-82.
4. Nordrehaug JE, Johannessen KA, von der Lippe G. Serum potassium
concentration as a risk factor of ventricular arrhythmias early
in acute myocardial infarction. Circulation. 1985;71:645-9.
5. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines
for the management of patients with ST-elevation myocardial
infarction: a report of the American College of Cardiology/ American
Heart Association Task Force on Practice Guidelines (Writing
Committee to Revise the 1999 Guidelines for the Management of
Patients With Acute Myocardial Infarction). J Am Coll Cardiol. 2004;
44:671-719.
6. Shiyovich A, Gilutz H, Plakht Y. Serum potassium levels and longterm
post-discharge mortality in acute myocardial infarction. Int J
Cardiol. 2014;172:e368-e370.
7. Goyal A, Spertus JA, Gosch K, et al. Serum potassium levels and
mortality in acute myocardial infarction. JAMA. 2012;307(2): 157-
164.
8. Uluganyan M, Ekmekci A, Murat A, et al. Admission serum potassium
level is associated with in-hospital and long-term mortality in
ST-elevation myocardial infarction. Anatol J Cardiol. 2016 6(1):10-15.
9. Shiyovich A, Gilutz H, Ygal Plakh. Potassium Fluctuations Are
Associated With In-hospital Mortality From Acute Myocardial
Infarction. Soroka Acute Myocardial Infarction II (SAMI-II) Project.
Angiology. 2018;69:709-717.
10. Shiyovich A, Plakht Y. MyoK+ardial Infarction: potassium levels
and outcomes following acute myocardial infarction. Angiology.
2016; 67:725-728.
11. Sekiyama H, Nagoshi T, Komukai K, et al. Transient decrease in
serum potassium level during ischemic attack of acute coronary
syndrome: paradoxical contribution of plasma glucose level and
glycohemoglobin. Cardiovasc Diabetol. 2013;12:4
12. Peng Y, Huang FY, Liu W, et al. Relation between admission
serum potassium levels and long-term mortality in acute coronary
syndrome. Intern Emerg Med. 2015; 10:927-935.
13. Tsai IT, Wang CP, Lu YC, Hung WC, Wu CC, Lu LF, Chung FM,
Hsu CC, Lee YJ, Yu TH. The burden of major adverse cardiac events
in patients with coronary artery disease. BMC Cardiovasc Disord.
2017; 17:1.
14. Koplan BA, MD, Stevenson WG. Ventricular Tachycardia and
Sudden Cardiac Death. Mayo Clin Proc. 2009; 84: 289–297.
15. Singh SM, FitzGerald G, Yan AT, Brieger D, Fox KA, López-Sendón
J, Yan RT, Eagle KA, Steg PG, Budaj A, Goodman SG. High-grade
atrioventricular block in acute coronary syndromes: insights from
the Global Registry of Acute Coronary Events. European Heart
Journal. 2015; 36: 976–98316. Thygesen K, Alpert JS, Jaffe AS, et al. Writing Group on behalf of
the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition
of Myocardial Infarction. Third universal definition of myocardial
infarction. Eur Heart J. 2012; 33: 2551-67.
17. Wali MV, Yatiraj S. Study of serum sodium and potassium in
acute myocardial infarction. J Clin Diagn Res. 2014; 8:7-9.
18. Hoppe LK, Muhlack DC, Koenig W, Carr PR, Brenner H, Schöttker
B. Association of Abnormal Serum Potassium Levels with Arrhythmias
and Cardiovascular Mortality: a Systematic Review and Meta-
Analysis of Observational Studies. Cardiovasc Drugs Ther. 2018;
32:197-212.
19. Choi JS, Kim YA, Kim HY, et al. Relation of serum potassium level
to long-term outcomes in patients with acute myocardial infarction.
Am J Cardiol. 2014; 113:1285-1290.
20. Shlomai G, Berkovitch A, Pinchevski-Kadir S, et al. The association
between normal-range admission potassium levels in Israeli patients
with acute coronary syndrome and early and late outcomes.
Medicine (Baltimore). 2016; 9:e3778.
21. Honda T, Fujimoto K, Miyao Y, Koga H, Ishii M. Potassium
concentration on admission is an independent risk factor for target
lesion revascularization in acute myocardial infarction. Sci World J.
2014; 2014:946803.
22. Roos M, Ndrepepa G, Baumann M, et al. Serum potassium levels
on admission and infarct size in patients with acute myocardial
infarction. Clin Chim Acta 2009;409:46–51.