Key result
Potassium 4.5 to <5.0 mEq/L linked to ~52% higher 30-day STEMI mortality vs 4.0 to <4.5.
Why the study?
Current guidelines recommend maintaining serum potassium levels between 4.0 and 5.0 mEq/L in acute myocardial infarction patients, but these are based on studies before the β blocker and reperfusion era.
Do serum potassium levels >4.5 mEq/L increase mortality risk in patients with STEMI compared to levels of 4.0-4.5 mEq/L?
Cohort (n=6,613)
Do serum potassium levels >4.5 mEq/L increase mortality risk in patients with STEMI compared to levels of 4.0-4.5 mEq/L?
Hazard Ratio: 1.52 (95% CI 1.17–1.98)
p-value: p=.002
In patients with STEMI, maintaining serum potassium levels between 4.0 and 4.5 mEq/L is associated with the lowest 30-day mortality, challenging current guidelines that recommend a broader range of 4.0 to 5.0 mEq/L.
May support narrower potassium targets in STEMI; hypothesis-generating and requires randomized confirmation before practice change.
Current guidelines recommend maintaining serum potassium levels between 4.0 and 5.0 mEq/L (1 mEq/L = mmol/L) in patients with acute myocardial infarction. However, these guidelines are based on studies conducted before the β blocker and reperfusion era. We retrospectively analyzed 6613 patients diagnosed with ST-segment elevation myocardial infarction (STEMI) who presented without renal insufficiency. Patients were categorized into 5 groups according to mean serum potassium levels: <3.5, 3.5 to <4.0, 4.0 to <4.5, 4.5 to <5.0, and ≥5.0 mEq/L. Patients with potassium levels of 4.0 to <4.5 mEq/L had the lowest predefined event rates, which were 6.4% for 7-day malignant arrhythmia, 3.7% for 7-day mortality, and 5.3% for 30-day mortality. Compared with the reference group (4.0 to <4.5 mEq/L), multivariate regression analysis revealed significantly higher 30-day mortality risk in patients with potassium level of 4.5 to <5.0 (hazard ratio [HR]: 1.52, 95% confidence interval [CI]: 1.17-1.98; P = .002) and even higher risk in patients with potassium level of ≥5.0 mEq/L (HR: 1.80, 95% CI: 1.22-2.66; P = .002). The lowest 30-day mortality was observed in patients with STEMI having potassium levels between 4.0 and 4.5 mEq/L, and a level >4.5 mEq/L significantly increased mortality risk.
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Ma et al. (2015) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=6,613). Serum potassium level 4.5 to <5.0 mEq/L vs. Serum potassium level 4.0 to <4.5 mEq/L was evaluated on 30-day mortality (HR 1.52, 95% CI 1.17-1.98, p=.002). In patients with STEMI, serum potassium levels of 4.5 to <5.0 mEq/L significantly increased 30-day mortality risk compared to levels of 4.0 to <4.5 mEq/L (HR 1.52; 95% CI 1.17-1.98; P=.002).
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