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Effects of Serum Potassium on Mortality in Patients With ST-Elevation Myocardial Infarction

Colton J Jensen1, Jonathan K Nielsen1, Matthew M Talbott1

  • 1Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA.

Cureus
|June 26, 2024
PubMed

Insights

Potassium levels impact ST-elevation myocardial infarction (STEMI) outcomes. Both low (hypokalemia) and high (hyperkalemia) potassium significantly increase mortality and ventricular arrhythmias in STEMI patients.

Area of Science:

  • Cardiology
  • Clinical Research
  • Biomedical Science

Background:

  • Potassium disturbances are known to trigger ventricular arrhythmias and increase mortality in ST-elevation myocardial infarction (STEMI) patients.
  • Existing clinical guidelines may not fully address the risks associated with varying serum potassium (sK) levels in STEMI.

Purpose of the Study:

  • To investigate the association between serum potassium (sK) levels and seven-day mortality in STEMI patients.
  • To determine the impact of sK levels on the incidence of ventricular arrhythmias (ventricular tachycardia and ventricular fibrillation) in STEMI.

Main Methods:

  • A retrospective analysis of approximately 250,000 STEMI patients from the TriNetX database.
  • Patients were categorized into four sK cohorts: hypokalemia (≤3.4 mEq/L), normal (3.5–4.5 mEq/L), high-normal (4.6–5.0 mEq/L), and hyperkalemia (≥5.1 mEq/L).
  • Propensity-matched analysis was used to compare seven-day mortality, ventricular tachycardia (VT), and ventricular fibrillation (VF) rates across cohorts.

Main Results:

  • Hypokalemia was associated with a 69% increased risk of seven-day mortality (RR 1.69) and higher VT/VF rates compared to normal sK.
  • Hyperkalemia showed a 176% increased risk of mortality (RR 2.76) and elevated VT/VF rates.
  • High-normal sK levels were linked to a 58% increased mortality risk (RR 1.58) without a significant change in VT/VF rates.

Conclusions:

  • Serum potassium levels, including hypokalemia, hyperkalemia, and high-normal ranges, are significantly correlated with increased mortality in STEMI patients.
  • Both hypokalemia and hyperkalemia substantially elevate the risk of life-threatening ventricular arrhythmias (VT/VF).
  • The findings underscore the importance of monitoring and managing potassium levels in STEMI management to improve patient outcomes.
Abstract

Keywords:
cardiologyemergency medicinepotassiumst-elevation myocardial infarctionventricular dysrhythmia

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