背景:在ST段抬高型心肌梗死(STEMI)患者中,钾水平的紊乱可诱发室性心律失常并增加死亡率。这项研究评估了sK水平对STEMI患者7天死亡率和室性心律失常发生率的影响,以进一步改善临床指南和预后。
方法:本回顾性研究,倾向匹配研究分析了TriNetX数据库美国协作网络中55个主要学术医疗中心/医疗机构(HCOs)的约250,000例急性STEMI患者.STEMI诊断当天记录的sK水平分为四个队列:sK≤3.4(低钾血症),3.5≤sK≤4.5(正常对照),4.6≤sK≤5.0(高-正常),和sK≥5.1(高钾血症)。使用人口统计学的线性和逻辑回归对患者队列进行倾向匹配。七天死亡率的结果,室性心动过速(VT),和心室纤颤(VF)在这些队列和对照组之间进行比较。
结果:分析显示低钾血症与7天死亡率显著升高有关(7.2%vs.4.3%;RR1.69;p<0.001),室性心动过速和室性心动过速增加。同样,高钾血症与死亡率升高相关(12.7%vs.4.6%;RR2.76;p<0.001),VT,和VF费率。高正常sK水平显示死亡率增加(7.4%vs.4.7%;RR1.58;p<0.001),但与正常sK组相比,VT或VF率没有变化。
结论:这项综合研究强调了STEMI患者sK水平与死亡的相关性,显示低钾血症的死亡率几乎增加了一倍,高钾血症的死亡率几乎增加了三倍。更值得注意的是,高正常值与正常sK值组的STEMIs死亡率较高.此外,研究发现,低钾血症和高钾血症显著增加VT和VF风险.
BACKGROUND: Disturbances in potassium levels can induce ventricular arrhythmias and heighten mortality in patients with ST-elevation myocardial infarction (STEMI). This study evaluates the influence of sK levels on seven-day mortality and incidence of ventricular arrhythmias in STEMI patients to further improve clinical guidelines and outcomes.
METHODS: This retrospective, propensity-matched study analyzed approximately 250,000 acute STEMI patients from 55 major academic medical centers/healthcare organizations (HCOs) in the US Collaborative Network of the TriNetX database. The sK levels recorded on the day of STEMI diagnosis were categorized into four cohorts: sK ≤ 3.4 (hypokalemia), 3.5 ≤ sK ≤ 4.5 (normal-control), 4.6 ≤ sK ≤ 5.0 (high-normal), and sK ≥ 5.1 (hyperkalemia). Patient cohorts were propensity-matched using linear and logistic regression for demographics. Outcomes of seven-day mortality, ventricular tachycardia (VT), and ventricular fibrillation (VF) were compared between these cohorts and the control group.
RESULTS: The analysis showed hypokalemia was linked to significantly higher seven-day mortality (7.2% vs. 4.3%; RR 1.69; p<0.001), and increased rates of VT and VF. Similarly, hyperkalemia was associated with elevated mortality (12.7% vs. 4.6%; RR 2.76; p<0.001), VT, and VF rates. High-normal sK levels showed increased mortality (7.4% vs. 4.7%; RR 1.58; p<0.001), but unchanged VT or VF rates compared to the normal sK group.
CONCLUSIONS: This comprehensive study highlights the correlation of sK levels with death in STEMI patients, revealing a nearly doubled risk of mortality with hypokalemia and almost triples with hyperkalemia. More notably, the mortality for STEMIs is higher for high-normal vs normal sK values. Additionally, hypokalemia and hyperkalemia were found to significantly elevate VT and VF risks.