Abstract
Aim: To find out the prognostic importance of hyponatremia in relation with survival outcome in patients with acute STEMI.
Materials and Methods: 200 patients presenting to the emergency department of medicine of RNT medical college and associated hospital from May 2017 to November 2017, with signs and symptoms of Acute STEMI, were included in the study with their informed consent and after applying the inclusion and exclusion criteria. Plasma sodium levels were assessed on admission, and at 24hr, 48 hr and 72 hr thereafter, with hyponatremia being defined as levels less than 135 meq/l.
Results: The study comprised of 132 cases (66%) with normal sodium levels, 28 cases (14%) with hyponatremia on admission, and 40 cases (20%) who developed hyponatremia after admission within 72 hrs. Hyponatremic cases were significantly associated with higher mortality, more no. of risk factors, higher killip class, reduced ejection fraction and higher Troponin T values.
Conclusion: Hyponatremia on admission or early development of hyponatremia in patients with acute STEMI is an independent predictor of 30-day mortality, thus serving to identify patients at high risk.
References
- Jeldsen KK. Hypokalemia and sudden cardiac death. Exp Clin Cardiol. 2010;15: 96-99.
- K Park. Park’s Textbook of Preventive and Social Medicine, 22nd ed. Jabalpur: Bhanot Publishers; 2013: p 338.
- Dasti MA, Hashmi SFA, Baloch GH, Shah SZA. Acute myocardial infarction; serum zinc level in patients. Professional Med J. 2013; 20 (4): 556-561.
- Antman EM, Braunwald E. ST segment elevation mycocardial Infarction In : Zipes, Libby, Bonow, Braunwald editors. Braunwalds Heart disease a textbook of cardiovascular medicine. 7 th edn. Philadelphia: Elsevier Saunders; 2005: 1141-1142.
- Rodríguez-Roisin R, Krowka MJ, Hervé P, Fallon MB. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J 2004; 24 (5): 861–80.
- Mendez-Sanchez N, Villa AR, Chavez-Tapia NC, Ponciano-Rodriguez G, Almeda Valdes P, Gonzalez D, et al. Trends in liver disease prevalence in Mexico from 2005 to 2050 through mortality data. Ann Hepatol 2005; 4: 52-5.
- National Center for Health Statistics. National Vital Statistics Report. Chronic liver disease / cirrhosis [online] 2009 Mar 06 [cited 2009 April 05]. Available from URL: http://www.cdc.gov/nchs/fastats/liverdis.htm
- Goldberg A, Hammerman H, Petcherski S, Zdorovyak A, Yalonetsky S, Kapeliovich M, et al. Prognostic importance of hyponatremia in acute ST-elevation myocardial infarction. Am J Med 2004; 117: 242- 8.
- Klopotowski M, Kruk M, Przyluski J, Kalinczuk L, Pregowski J, Bekta P, et al. Sodium level on admission and in-hospital outcomes of STEMI patients treated with primary angioplasty: The ANIN Myocardial Infarction registry. Med Sci Monit 2009; 15: CR477-83.
- Goldberg A, Hammerman H, Petcherski S, Nassar M, Zdorovyak A, Yalonetsky S, et al. Hyponatremia and long-term mortality in survivors of acute ST-elevation myocardial infarction. Arch Intern Med 2006; 166: 781-86.
- Flear CT, Hilton P. Hyponatremia and severity and outcome of myocardial infarction. BMJ. 1979; 1: 1242-1246.
- Shringi P, Meena SR. Impact of Hyponatremia on Survival of Acute St-Elevation Myocardial Infarction Patients during 30 Days. International Journal of Science and Research (IJSR) 2015; 4(12): 956-958.
- Kurian S, Mohanty N , Giri S, George R. Study of Hyponatremia in Acute ST-Elevation Myocardial Infarction and Its Prognostic Importance. J Med Res Prac 2017; 6(2): 56–61.
- Harsoor S, Kinagi A, Afiya S. A prospective study of in hospital outcome of acute phase of STEMI with hyponatremia.J of Evolution of Med and Dent Sci 2014; 3(67): 14483-492.
- Lazzeri C, Valente S, Chiostri M, Attana P, Picariello C, and Gensini GF. Usefulness of Hyponatremia in the Acute Phase of ST-ElevationMyocardial Infarction as a Marker of Severity. Am J Cardiol 2012; 110: 1419–1424.
Corresponding Author
Dr Vikas
Resident, Department of General Medicine
R.N.T Medical College, Udaipur, India
DOI: https://dx.doi.org/10.18535/jmscr/v6i8.24
