Dyskalemias and adverse events associated with discharge potassium in acute myocardial infarction

Hong Xu, Jonas Faxén, Karolina Szummer, Marco Trevisan, Csaba Kovesdy, Tomas Jernberg, Juan Jesús Carrero

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: The incidence of dyskalemias and associated outcomes in acute myocardial infarction (AMI) are unknown in real-world settings and likely differ from the controlled environment of randomized controlled trials. Methods: We examined consecutive survivors of an AMI during 2006-2011 in SWEDEHEART registry and with plasma potassium at discharge (exposure). Study outcomes were 1-year risk of hyperkalemia (potassium >5.0 mmol/L), hypokalemia (potassium <3.5 mmol/L), and others (1-year risk of death, new myocardial infarction, heart failure, and de novo atrial fibrillation). Covariates included demographics, comorbidities, hospital procedures, and medications. Results: We included 4,861 patients (65% male, age 71.4 ± 12.6 years) with mean discharge potassium of 4.0 ± 0.4 mmol/L. Within 1 year, 784 (16.1%) new hyperkalemic and 991 (20.4%) new hypokalemic events occurred. Discharge potassium and kidney dysfunction were independent predictors of their occurrence. Compared with discharge potassium of 4.0 to <4.5 mmol/L, the adjusted risk of incident hyperkalemia was 1.71 (95% confidence interval 1.41-2.06) for potassium of 4.5-5.0 mmol/L and 2.38 (1.69-3.35) for potassium of >5.0 mmol/L; the adjusted risk of incident hypokalemia was 1.43 for potassium of 3.5 to <4.0 mmol/L (1.23-1.66) and 3.12 (2.58-3.77) for potassium of <3.5 mmol/L. A U-shaped association was observed between discharge potassium and the risk of death (n = 718), with increased hazards for potassium <3.5 and >4.5 mmol/L. No association was found between discharge potassium and the risk of new myocardial infarction, heart failure, or de novo atrial fibrillation. Conclusions: Among real-world AMI survivors, both hyperkalemia and hypokalemia are frequent. Discharge potassium and kidney function strongly predicted their occurrence, as well as the 1-year risk of death.

Original languageEnglish (US)
Pages (from-to)53-62
Number of pages10
JournalAmerican Heart Journal
Volume205
DOIs
StatePublished - Nov 1 2018

Fingerprint

Potassium
Myocardial Infarction
Hypokalemia
Hyperkalemia
Controlled Environment
Atrial Fibrillation
Registries
Randomized Controlled Trials
Heart Failure
Outcome Assessment (Health Care)
Kidney
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Dyskalemias and adverse events associated with discharge potassium in acute myocardial infarction. / Xu, Hong; Faxén, Jonas; Szummer, Karolina; Trevisan, Marco; Kovesdy, Csaba; Jernberg, Tomas; Carrero, Juan Jesús.

In: American Heart Journal, Vol. 205, 01.11.2018, p. 53-62.

Research output: Contribution to journalArticle

Xu, Hong ; Faxén, Jonas ; Szummer, Karolina ; Trevisan, Marco ; Kovesdy, Csaba ; Jernberg, Tomas ; Carrero, Juan Jesús. / Dyskalemias and adverse events associated with discharge potassium in acute myocardial infarction. In: American Heart Journal. 2018 ; Vol. 205. pp. 53-62.
@article{2a29e3558bb24b818f2bc38b9dc15264,
title = "Dyskalemias and adverse events associated with discharge potassium in acute myocardial infarction",
abstract = "Background: The incidence of dyskalemias and associated outcomes in acute myocardial infarction (AMI) are unknown in real-world settings and likely differ from the controlled environment of randomized controlled trials. Methods: We examined consecutive survivors of an AMI during 2006-2011 in SWEDEHEART registry and with plasma potassium at discharge (exposure). Study outcomes were 1-year risk of hyperkalemia (potassium >5.0 mmol/L), hypokalemia (potassium <3.5 mmol/L), and others (1-year risk of death, new myocardial infarction, heart failure, and de novo atrial fibrillation). Covariates included demographics, comorbidities, hospital procedures, and medications. Results: We included 4,861 patients (65{\%} male, age 71.4 ± 12.6 years) with mean discharge potassium of 4.0 ± 0.4 mmol/L. Within 1 year, 784 (16.1{\%}) new hyperkalemic and 991 (20.4{\%}) new hypokalemic events occurred. Discharge potassium and kidney dysfunction were independent predictors of their occurrence. Compared with discharge potassium of 4.0 to <4.5 mmol/L, the adjusted risk of incident hyperkalemia was 1.71 (95{\%} confidence interval 1.41-2.06) for potassium of 4.5-5.0 mmol/L and 2.38 (1.69-3.35) for potassium of >5.0 mmol/L; the adjusted risk of incident hypokalemia was 1.43 for potassium of 3.5 to <4.0 mmol/L (1.23-1.66) and 3.12 (2.58-3.77) for potassium of <3.5 mmol/L. A U-shaped association was observed between discharge potassium and the risk of death (n = 718), with increased hazards for potassium <3.5 and >4.5 mmol/L. No association was found between discharge potassium and the risk of new myocardial infarction, heart failure, or de novo atrial fibrillation. Conclusions: Among real-world AMI survivors, both hyperkalemia and hypokalemia are frequent. Discharge potassium and kidney function strongly predicted their occurrence, as well as the 1-year risk of death.",
author = "Hong Xu and Jonas Fax{\'e}n and Karolina Szummer and Marco Trevisan and Csaba Kovesdy and Tomas Jernberg and Carrero, {Juan Jes{\'u}s}",
year = "2018",
month = "11",
day = "1",
doi = "10.1016/j.ahj.2018.06.009",
language = "English (US)",
volume = "205",
pages = "53--62",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Dyskalemias and adverse events associated with discharge potassium in acute myocardial infarction

AU - Xu, Hong

AU - Faxén, Jonas

AU - Szummer, Karolina

AU - Trevisan, Marco

AU - Kovesdy, Csaba

AU - Jernberg, Tomas

AU - Carrero, Juan Jesús

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: The incidence of dyskalemias and associated outcomes in acute myocardial infarction (AMI) are unknown in real-world settings and likely differ from the controlled environment of randomized controlled trials. Methods: We examined consecutive survivors of an AMI during 2006-2011 in SWEDEHEART registry and with plasma potassium at discharge (exposure). Study outcomes were 1-year risk of hyperkalemia (potassium >5.0 mmol/L), hypokalemia (potassium <3.5 mmol/L), and others (1-year risk of death, new myocardial infarction, heart failure, and de novo atrial fibrillation). Covariates included demographics, comorbidities, hospital procedures, and medications. Results: We included 4,861 patients (65% male, age 71.4 ± 12.6 years) with mean discharge potassium of 4.0 ± 0.4 mmol/L. Within 1 year, 784 (16.1%) new hyperkalemic and 991 (20.4%) new hypokalemic events occurred. Discharge potassium and kidney dysfunction were independent predictors of their occurrence. Compared with discharge potassium of 4.0 to <4.5 mmol/L, the adjusted risk of incident hyperkalemia was 1.71 (95% confidence interval 1.41-2.06) for potassium of 4.5-5.0 mmol/L and 2.38 (1.69-3.35) for potassium of >5.0 mmol/L; the adjusted risk of incident hypokalemia was 1.43 for potassium of 3.5 to <4.0 mmol/L (1.23-1.66) and 3.12 (2.58-3.77) for potassium of <3.5 mmol/L. A U-shaped association was observed between discharge potassium and the risk of death (n = 718), with increased hazards for potassium <3.5 and >4.5 mmol/L. No association was found between discharge potassium and the risk of new myocardial infarction, heart failure, or de novo atrial fibrillation. Conclusions: Among real-world AMI survivors, both hyperkalemia and hypokalemia are frequent. Discharge potassium and kidney function strongly predicted their occurrence, as well as the 1-year risk of death.

AB - Background: The incidence of dyskalemias and associated outcomes in acute myocardial infarction (AMI) are unknown in real-world settings and likely differ from the controlled environment of randomized controlled trials. Methods: We examined consecutive survivors of an AMI during 2006-2011 in SWEDEHEART registry and with plasma potassium at discharge (exposure). Study outcomes were 1-year risk of hyperkalemia (potassium >5.0 mmol/L), hypokalemia (potassium <3.5 mmol/L), and others (1-year risk of death, new myocardial infarction, heart failure, and de novo atrial fibrillation). Covariates included demographics, comorbidities, hospital procedures, and medications. Results: We included 4,861 patients (65% male, age 71.4 ± 12.6 years) with mean discharge potassium of 4.0 ± 0.4 mmol/L. Within 1 year, 784 (16.1%) new hyperkalemic and 991 (20.4%) new hypokalemic events occurred. Discharge potassium and kidney dysfunction were independent predictors of their occurrence. Compared with discharge potassium of 4.0 to <4.5 mmol/L, the adjusted risk of incident hyperkalemia was 1.71 (95% confidence interval 1.41-2.06) for potassium of 4.5-5.0 mmol/L and 2.38 (1.69-3.35) for potassium of >5.0 mmol/L; the adjusted risk of incident hypokalemia was 1.43 for potassium of 3.5 to <4.0 mmol/L (1.23-1.66) and 3.12 (2.58-3.77) for potassium of <3.5 mmol/L. A U-shaped association was observed between discharge potassium and the risk of death (n = 718), with increased hazards for potassium <3.5 and >4.5 mmol/L. No association was found between discharge potassium and the risk of new myocardial infarction, heart failure, or de novo atrial fibrillation. Conclusions: Among real-world AMI survivors, both hyperkalemia and hypokalemia are frequent. Discharge potassium and kidney function strongly predicted their occurrence, as well as the 1-year risk of death.

UR - http://www.scopus.com/inward/record.url?scp=85052322198&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052322198&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2018.06.009

DO - 10.1016/j.ahj.2018.06.009

M3 - Article

VL - 205

SP - 53

EP - 62

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

ER -