Influence of electrolyte balance on the prognosis of long-term cardiovascular events after acute coronary syndrome

Aim . To assess the effect of electrolyte changes on the prognosis of long-term cardiovascular events after acute coronary syndrome (ACS). Material and methods . The study included 105 patients with ACS who underwent coronary angiography (CA) with coronary stenting. At the study inclusion (before CA...

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Published in:	Kardiovaskuli͡a︡rnai͡a︡ terapii͡a︡ i profilaktika Vol. 19; no. 4; p. 2612
Main Authors:	Levitskaya, E. S., Batyushin, M. M., Gulchenko, V. V., Khripun, A. V., Sarkisyan, S. S., Lazutkina, N. A., Ishmakova, R. A., Zarina, N. S.
Format:	Journal Article
Language:	English Russian
Published:	SILICEA-POLIGRAF» LLC 05-09-2020
Subjects:	acute coronary syndrome electrolyte balance free water clearance kaliuresis natriuresis tubular dysfunction
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Summary:	Aim . To assess the effect of electrolyte changes on the prognosis of long-term cardiovascular events after acute coronary syndrome (ACS). Material and methods . The study included 105 patients with ACS who underwent coronary angiography (CA) with coronary stenting. At the study inclusion (before CA with coronary stenting), we collected data on traditional risk factors, analyzed levels of urinary sodium and potassium, kaliuresis and natriuresis. Free water clearance (FWC) and electrolyte free water clearance (EFWC), as well as fluid balance using bioelectrical impedance analysis were determined. Study endpoints (fatal and nonfatal cardiovascular events) were determined 6,2±0,2 months after CA with coronary stenting. Results . It was found that a decrease in urinary sodium (χ2=5,64, p=0,02, Constanta B0 =-0,62, Estimate =-16,5) and natriuresis (χ 2 =4,1, р=0,044, Constanta B0 =-1,38, Estimate =-5,2) increase the death risk. Urinary sodium of 0,2 mol/L and natriuresis of 0,5 mol are threshold levels of increased risk of death. Urinary potassium decrease was associated with an increase in death risk (threshold level — 0,5 mol/L, χ2=4,99, р=0,025, Constanta B0 =-0,63, Estimate =-70,4) and acute myocardial infarction (threshold level — 0,06 mol/L, χ2=3,93, р=0,04, Constanta B0 =-0,99, Estimate =-58,0) in the long-term period. Increase in EFWC increased the likelihood of long-term transient ischemic attack after ACS (χ2=4,61, р=0,03, Constanta B0 =-2,95, Estimate =-1,0). There were no significant relationships in the matter of FWC (p>0,05). However, with a decrease in intracellular fluid volume compared to normal values and a decrease in FWC or an increase in EFWC, the likelihood of longterm composite endpoints after ACS increases. Conclusion . As a result of the study, risk markers for long-term fatal and non-fatal cardiovascular events after ACS were established: decrease in urinary sodium <0,2 mol/l and potassium <0,5 mol/l; decrease in FWC and increase in EFWC with or without cellular dehydration. The established markers can complement the current cardiovascular risk score methods in patients with ACS.
ISSN:	1728-8800 2619-0125
DOI:	10.15829/1728-8800-2020-2612