Abstract
BackgroundAlthough a decrease in serum potassium level has been suggested to be a fairly common observation in acute coronary syndrome (ACS), there have so far been no definitive reports directly demonstrating the transient potassium decrease (the potassium dip) during ischemic attack of ACS compared to stable phase in individual patients. To understand the pathophysiological significance of the potassium dip, we examined the changes in serum potassium level throughout ischemic attack and evaluated the clinical factors affecting it.MethodsThe degree of the potassium dip during ischemic attack (as indicated by ΔK, ΔK = K at discharge − K on admission) was examined in 311 consecutive patients with ACS who required urgent hospitalization in our institution.ResultsSerum potassium level during ischemic attack was significantly decreased compared to that during stable phase (P < 0.001). Multiple regression analysis revealed that plasma glucose level during attack was the sole factor which was positively correlated with ΔK (P < 0.01), while HbA1c level was negatively correlated (P < 0.05). The medication profiles and renal function had no impact on ΔK. A longer hospitalization period, higher incidence of myocardial infarction and higher peak creatine kinase level were observed in patients with a larger ΔK.ConclusionsWe have clearly demonstrated that there is a transient decrease in serum potassium level during ischemic attack of ACS compared to stable phase. The degree of the potassium dip was tightly correlated with glucose level, which overwhelmed the diabetic condition, and it also indicates the disease severity. The present study therefore promotes awareness of the significance of monitoring potassium level in parallel with glucose level in patients with ACS.
Highlights
A decrease in serum potassium level has been suggested to be a fairly common observation in acute coronary syndrome (ACS), there have so far been no definitive reports directly demonstrating the transient potassium decrease during ischemic attack of ACS compared to stable phase in individual patients
Definitions of the medication profiles To evaluate the involvement of renin-angiotensinaldosterone system inhibitors (RAAS-I) and diuretics, we examined the influence of the changes in each medication profile as follows: “no change” indicates that those medications were or were not taken both on admission and at the time of discharge; “newly administered” indicates that those medications were not taken on admission but were introduced during hospitalization; “discontinuation” indicates that those medications were taken on admission but were discontinued during hospitalization
We examined multiple clinical factors affecting the degree of the potassium dip, and found that the plasma glucose level during ischemic attack was the sole factor which was positively correlated with ΔK
Summary
A decrease in serum potassium level has been suggested to be a fairly common observation in acute coronary syndrome (ACS), there have so far been no definitive reports directly demonstrating the transient potassium decrease (the potassium dip) during ischemic attack of ACS compared to stable phase in individual patients. The mean value of K concentration on admission was around 4.0 mmol/L in all of the previous reports, which is not technically defined as hypokalemia To see this transient K decrease, “the potassium dip,” during ischemic attack, it would be necessary to evaluate the fluctuation of K level in individuals by comparing the data during an attack to those during stable phase. To understand the pathophysiological significance of the potassium dip in ACS and to ensure that patients have an optimal serum K level during the acute phase of ischemic attack, we examined the changes in K level throughout ischemic attack and evaluated the clinical factors affecting it
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