Title : New paradigm in pharmacological management of serum potassium levels in acute coronary syndrome: which cut-off is optimal and safe?
Acute coronary syndrome (ACS) is one of the leading causes of increased morbidity and mortality worldwide. Although ACS-related mortality has been profoundly linked with the serum potassium level on admission, recent results seem to contradict the established guidelines.
Aims. To determine the association between serum potassium levels on admission in ACS patients and in-hospital mortality. This study also aims to redefine the optimal serum potassium target in ACS patients.
Methods and Results. All-cause in-hospital mortality was monitored as the outcome among 673 ACS patients hospitalised in Indonesian National Cipto Mangunkusumo Hospital. Logistic regression models adjusted for risk factors, hospital treatment and comorbidities were constructed. Total of 163 patients (24.22%) found with abnormal serum potassium levels. (K < 3.50 mEq/L or > 5.0 mEq/L). Logistic regression shows significant association between serum potassium levels on admission and in-hospital mortality with p value of 0.04 (adjusted RR 2.184; 95% CI: 1.037-4.601). The risk of mortality of subjects with serum potassium levels of 4.0-4.49 mEq/L was increased compared to reference level of 3.50-3.99 mEq/L (RR 1.4; 95% CI: 0.497-3.93).
Conclusion. ACS patients with abnormal serum potassium levels on admission have significant association with increased in-hospital mortality. Admission serum potassium levels of > 4.0 mEq/L may be associated with increased mortality risk in patients with ACS. Optimal target of serum potassium level in acute coronary syndrome may be considered to be redefined to a range of 3.50-3.99 mEq/L.
Audience take away:
- Abnormal serum potassium level on admission increases the in-hospital mortality risk. Our study challenges the established guidelines that recommends maintaining serum potassium levels above 4 mEq/L. Data from our study suggests that the optimal range of serum potassium levels in ACS patients, especially in Indonesia, may be in the range of 3.50-3.99 mEq/L, with levels greater than or equal to 4.00 mEq/L are associated with increased risk of in-hospital mortality
- Audience may gain substantial evidence and new perspective in redefining the optimal serum potassium target in acute coronary syndrome patients