title: Prevalence and Prognosis of Hyperkalemia in Patients with Acute Myocardial Infarction.
abstract: Hyperkalemia is common and potentially dangerous in hospitalized patients; its contemporary prevalence and prognostic importance after acute myocardial infarction are not well described.
  
  
  
  In 38,689 consecutive patients with acute myocardial infarction from the Cerner Health Facts database, we evaluated the association between maximum in-hospital potassium levels and in-hospital mortality. Patients were stratified by dialysis status and grouped by maximum potassium as follows: <5 mEq/L, 5 to <5.5 mEq/L, 5.5 to <6.0 mEq/L, 6.0 to <6.5 mEq/L, and ≥6.5 mEq/L. Multivariable logistic regression was used to adjust for multiple patient and site characteristics. The relationship between the number of hyperkalemic values and the in-hospital mortality was evaluated.
  
  
  
  Of 38,689 patients with acute myocardial infarction, 886 were on dialysis. The rate of hyperkalemia (maximum potassium ≥5.0 mEq/L) was 22.6% in patients on dialysis and 66.8% in patients not on dialysis. Moderate to severe hyperkalemia (maximum potassium ≥5.5 mEq/L) occurred in 9.8% of patients. There was a steep increase in mortality with higher maximum potassium levels. In-hospital mortality exceeded 15% once maximum potassium was ≥5.5 mEq/L regardless of dialysis status. The relationship between higher maximum potassium and increased mortality risk persisted after multivariable adjustment. In addition, patients with a greater number of hyperkalemic values (vs a single value) experienced higher in-hospital mortality.
  
  
  
  Hyperkalemia is common in patients who are hospitalized with acute myocardial infarction. Higher maximum potassium levels and number of hyperkalemic events are associated with a steep mortality increase, with higher risks for adverse outcomes observed even at mild levels of hyperkalemia. Whether more intensive management of hyperkalemia may improve outcomes in patients with acute myocardial infarction merits further study.
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Mo; University of Missouri-Kansas City. Electronic address: agrodzinsky@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Grodzinsky
authors.affiliation: Division of Cardiology, Emory Healthcare, and Emory School of Medicine, Atlanta, Ga.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Mo.
authors.forename: Kensey
authors.initials: K
authors.lastname: Gosch
authors.affiliation: Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Tex; The Heart Hospital, Plano, Tex.
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.affiliation: Division of Cardiology, University of California-Los Angeles.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Department of Anesthesia and Critical Care Medicine, Hôpitaux Universitaire, Saint Louis Lariboisière, University Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Mo; University of Missouri-Kansas City.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Division of Nephrology, University of Texas Southwestern Medical Center, Dallas.
authors.forename: Biff F
authors.initials: BF
authors.lastname: Palmer
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Mo; University of Missouri-Kansas City.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006947:Hyperkalemia / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D006435:Renal Dialysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Acute myocardial infarction; Dialysis; Hyperkalemia prevalence