A Study of the correlation between Potassium Dip and Severity of Acute Ischemic Stress in patients with Acute Coronary syndrome

BACKGROUND AND OBJECTIVES : Coronary artery disease is the important cause of mortality and morbidity in the world as well in India. Transient decrease in serum potassium during episode of acute coronary syndrome is thought to be a common finding, but so far there are not many studies demonstrating it occurrence in ACS and its significance. Delta potassium defined as the difference between potassium during the time of discharge and on admission [k-k at the time of discharge- k at the time of admission] reflect potassium drop during acute coronary syndrome and it has been thought to be associated with the disease severity in patient with ACS. Apart from well-known factors influencing mortality and morbidity in patient with acute coronary syndrome like female sex, associated co morbid illness like diabetes mellitus [DM], Systemic hypertension [SHT], dyslipidaemia, age, smoking, alcoholism, delta potassium has also thought to be associated with disease severity and influence the course of the disease in patients with ACS. The present study is an attempt to study its prevalence and its significance in patient of acute coronary syndrome group. METHODS AND MATERIALS : Study Design: Cross Sectional Study. Study Group: Patients with acute coronary syndrome 1. STEMI, 2. UNSTABLE ANGINA, 3. NSTEMI. MATERIALS : Detailed history, Physical examination, ECG, 2D Echocardiography, Chest x-ray, Complete Haemogram, Rbs, Blood urea, Serum Creatinine, Serum potassium, cardiac enzyme CPK-MB, Urine Routine, Total Cholesterol, Triglyceride levels. Place of Study: Govt. Kilpauk medical college hospital Duration of Study: 6 months METHODOLOGY : 1. Potassium dip will be assessed by Δk-potassium at the time of discharge – potassium at the time of admission. 2. Severity of ACS assessed by a) Duration of hospital stay b) 2D echo c) Cardiac enzyme CPK-MB assay. Inclusion Criteria : All patients > 35 yrs of age admitted with 1st episode of acute coronary syndrome. Exclusion Criteria : 1. Previous history of CAD. 2. Patients with CKD. 3. Patients on potassium controlling agents like ACE inhibitors, diuretics etc. RESULTS : Among 65 patients with STEMI 47 had delta potassium value more than 0.5 which constitute 72%. In patients with NSTEMI 66% has significant delta potassium. But in UNSTABLE ANGINA group only 23% has delta potassium more than 0.5. Delta potassium has also shown to be positively correlated with duration of stay in hospital as shown below. 1. Patient who stayed for 5 or less- 19% has significant delta potassium. 2. In the patient who stayed for 5 to 7- 76% has delta potassium more than 0.5. 3. In patients who stayed for more than 7 days- 96% has significant delta k. The relationship between delta potassium and LV dysfunction also correlate positively. In 17 patients with normal only 2 has delta potassium more than 2. In patients with mild LV dysfunction 33% has significant delta potassium. But 92% of patients with moderate and 93% of patients with severe LV dysfunction has delta potassium more than 0.5. CONCLUSION : 1. Prevalence of potassium dip is common among patients with acute coronary syndrome. 2. Diabetic patients does not have significant delta potassium. 3. Low potassium value at the time of admission [less than 4] was not found to correlate with disease severity in this study. 4. Delta potassium was positively correlated with severity of ischemic stress in patients with ACS. 5. Age, sex, diabetes, SHT, dyslipidaemia, smoking and alcoholism do not have major impact on delta potassium