Affiliation:
1. Department of Cardiology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
2. Department of Biostatistics University of Copenhagen Denmark
3. Department of Cardiology Bispebjerg and Frederiksberg University Hospital Copenhagen Denmark
4. Department of Cardiology Aalborg University Hospital Aalborg Denmark
5. Department of Forensic Medicine Faculty of Medical Science University of Copenhagen Denmark
6. Department of Cardiology University of Lund Sweden
Abstract
Background
Potassium disturbances per se increase the risk of ventricular fibrillation (
VF
). Whether potassium disturbances in the acute phase of
ST
‐segment–elevation myocardial infarction (
STEMI
) are associated with
VF
before primary percutaneous coronary intervention (
PPCI
) is uncertain.
Methods and Results
All consecutive
STEMI
patients were identified in the Eastern Danish Heart Registry from 1999 to 2016. Comorbidities and medication use were assessed from Danish nationwide registries. Potassium levels were collected immediately before
PPCI
start. Multivariate logistic models were performed to determine the association between potassium and
VF
. The main analysis included 8624
STEMI
patients of whom 822 (9.5%) had
VF
before
PPCI
. Compared with 6693 (77.6%) patients with normokalemia (3.5–5.0 mmol/L), 1797 (20.8%) patients with hypokalemia (<3.5 mmol/L) were often women with fewer comorbidities, whereas 134 (1.6%) patients with hyperkalemia (>5.0 mmol/L) were older with more comorbidities. After adjustment, patients with hypokalemia and hyperkalemia had a higher risk of
VF
before
PPCI
(odds ratio 1.90, 95%
CI
1.57–2.30,
P
<0.001) and (odds ratio 3.36, 95%
CI
1.95–5.77,
P
<0.001) compared with normokalemia, respectively. Since the association may reflect a post‐resuscitation phenomenon, a sensitivity analysis was performed including 7929
STEMI
patients without
VF
before
PPCI
of whom 127 (1.6%) had
VF
during
PPCI
. Compared with normokalemia, patients with hypokalemia had a significant association with
VF
during
PPCI
(odds ratio 1.68, 95%
CI
1.01–2.77,
P
=0.045) after adjustment.
Conclusions
Hypokalemia and hyperkalemia are associated with increased risk of
VF
before
PPCI
during
STEMI
. For hypokalemia, the association may be independent of the measurement of potassium before or after
VF
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
14 articles.
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