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Admission Serum Potassium in Patients With Acute Myocardial Infarction^*

Its Correlates and Value as a Determinant of In-Hospital Outcome

^* From the Mount Sinai School of Medicine of New York University, and the Division of Cardiology (Drs. J. Madias, Shah, Chintalapally, and Chalavarya), Elmhurst Hospital Center, Elmhurst, NY; and the Tufts University School of Medicine, and the Division of Nephrology (Dr. N. Madias), New England Medical Center, Boston, MA.

Correspondence to: John E. Madias, MD, Division of Cardiology, Elmhurst Hospital Center, 79–01 Broadway, Elmhurst, NY 11373, e-mail: jmad{at}pop.nychhc.org

Study objectives: Although controversial, hypokalemia (LK) in patients with acute myocardial infarction (MI) is thought to predict increased in-hospital morbidity, particularly cardiac arrhythmias, and mortality. Also, the mechanism of low serum potassium in the setting of MI has not been delineated. We evaluated the frequency, attributes, and outcome, and speculated on the mechanism of LK in patients with MI.

Design: This was a prospective cross-sectional study of 517 consecutive patients with MI admitted to the coronary care unit (CCU). Serum potassium was measured in the emergency department and repeatedly thereafter throughout hospitalization, and was used in the analysis, along with a large array of clinical and laboratory variables.

Results: The patients were allocated to a LK and a normokalemic (NK) cohort, based on the emergency department serum potassium measurement. The 41 patients with LK (3.16 ± 0.24 mEq/L; 7.9% of total) were comparable on admission in their baseline assessment to the 476 patients with normal serum potassium (4.28 ± 0.56 mEq/L), except for lower emergency department magnesium (1.48 ± 0.15 mg/dL vs 1.96 ± 0.26 mg/dL; p = 0.0005) and earlier presentation after onset of symptoms (3.0 ± 4.1 h vs 4.4 ± 6.2 h; p = 0.05). There was a poor correlation between serum potassium and magnesium on admission (r = 0.14). Peak creatine kinase (CK) and myocardial isomer of CK were higher in the LK patients (3,870 ± 3,840 IU/L vs 2,359 ± 2,653 IU/L [p = 0.018] and 358 ± 312 IU/L vs 228 ± 258 IU/L [p = 0.013], respectively). Management of the two cohorts was the same, except for a higher rate of use of magnesium (14.6% vs 4.6%; p = 0.007), serum potassium supplements (90.2% vs 43.1%; p = 0.000005), and antiarrhythmic drugs (78.0% vs 50.4%; p = 0.0007) in the LK patients. No difference was detected between the LK and NK patients in total mortality (24.4% vs 18.3%; p = 0.34), cardiac mortality (17.1% vs 15.3%; p = 0.52), atrial fibrillation (14.6% vs 13.9%; p = 0.89), and ventricular tachycardia (22.0% vs 16.0%; p = 0.32), but ventricular fibrillation (VF) occurred more often (24.4% vs 13.0%; p = 0.04) in the LK patients. However, proportions of VF occurring in the emergency department, CCU, or wards in the two cohorts were not different, but they were higher during the time interval prior to emergency department admission in LK patients (17.1% vs 2.1%; p = 0.00001).

Conclusions: LK is seen in approximately 8% of patients with MI in the emergency department; LK is associated with low emergency department magnesium, and low serum potassium levels in the CCU and throughout hospitalization. LK has no relationship to preadmission use of diuretics, it is associated with early presentation to the emergency department, and it is not a predictor of increased morbidity or mortality.

Key Words: cardiac arrest • diuretics • hypokalemia • myocardial infarction • potassium • sudden death • ventricular fibrillation

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