低钾血症对急性心肌梗死患者远期预后的影响

目的探讨低钾血症对急性心肌梗死(AMI)患者远期预后的影响，建立AMI患者COX比例风险回归模型。方法选择承德医学院附属医院心内科住院的AMI并行经皮冠状动脉介入治疗(PCI)的患者446例，符合纳入标准者均连续入选。依据患者住院期间最低血清钾离子(K)浓度＜3.5 mmol/L，将患者分为低钾血症组(K＜3.5 mmol/L)与正常血钾组(3.5≤K＜5.5 mmol/L)，分别为123例和323例。收集入组患者人口学特征、临床表现和治疗方案等资料，规律随访评估预后。结果低钾血症组主要心血管不良事件(MACE)发生率高于正常血钾组［21(17.1%)比32(9.9%)］(P＜0.05)。低钾血症组比正常血钾组患者全因病死率高［4(3.4%)比4(1.3%)］，但差异无统计学意义(P＞0.05)。COX比例风险回归模型显示：低钾血症、临床ST段抬高型心肌梗死(STEMI)、无胸痛均是AMI患者远期预后不良的独立危险因素(均P＜0.05)。结论低钾血症是AMI患者远期预后不良的独立危险因素之一，临床医生应给予高度关注、改善AMI患者预后。

Impact of hypokalemia on long term prognosis in patients with acute myocardial infarction

ObjectiveTo explore the impact of hypokalemia on long term prognosis of patients with acute myocardial infarction and establish COX multiple prognostic risk factors model for these patients. MethodsA total of 446 AMI inpatients undergoing percutaneous coronary intervention were consecutively enrolled in this study and divided into two groups: hypokalemia(K)＜3.5 mmol/L (n=123) and normal control，3.5≤K＜5.5 mmol/L (n=233). All the demographic and clinical data were collected by the physicians and master degree students in the departemnt， and then the prognosis of these patients were assessed after regular follow up. ResultsThe rates of MACE of the patients with hypokalemia were significantly higher than those in normal control group (17.1% vs 9.9%，P＜0.05). Hypokalemia group had higher mortality than normal control group，but the difference was not significant (3.4% vs 1.3%，P＞0.05). The Cox proportional regression model of multiple prognostic risk factors showed that hypokalemia， ST elevation myocardial infarction， and hidden chest pain were all independent risk factors poor long term prognosis of AMI patients(all P＜0.05). ConclusionHypokalemia is an independent risk factor of the poor long term prognosis of AMI patients.