Abstract 18092: The Relationship Between Patency of the Culprit Artery on Admission and Electrolyte Changes in Anterior STEMI - Analysis From the EMBRACE STEMI Clinical Trial
Introduction: During STEMI, the activation of the renin-aldosterone-angiotensin system (RAAS) has a vasoconstrictive effect which may contribute to cardiac ischemia and the final infarct size. Nonetheless, the association between RAAS-related electrolyte changes and the patency of the culprit artery on admission has not been explored. We compared the evolution of RAAS-related electrolyte changes between STEMI patients with occluded LAD vs. patent LAD on admission.
Methods: Patients with STEMI of the LAD who were enrolled in the phase 2 EMBRACE STEMI randomized trial with no collateralization in the culprit artery were analyzed (n=271). Culprit artery occlusion was defined as TIMI flow grade ≤1.
Results: A total of 140 (51.7%) patients had complete LAD occlusion on admission. The evolution of urinary and serum electrolytes and urinary osmolarity are shown in the figure. Compared with patients with patent LAD, patients with LAD occlusion had significantly lower serum potassium and higher serum sodium concentrations, as well as higher urine osmolarity and more acidic pH, all of which are electrolyte changes that are consistent with a greater activation of the RAAS system. The incidence of hypokalemia was more than two-folds higher among patients with LAD occlusion as compared with patients with a patent LAD (10.7%  vs. 25.0% , p=0.002). This association remained significant when controlling for imbalances in gender, duration of symptoms, diabetes, serum creatinine, and troponin concentration on admission (OR=2.5, 95% CI (1.2, 5.4), p=0.018).
Conclusions: Among patients with anterior STEMI, LAD occlusion on admission is associated with electrolyte changes consistent with a greater activation of the renin-aldosterone-angiotensin system as compared with a patent LAD.
Author Disclosures: S. Korjian: None. Y. Daaboul: None. R.A. Kloner: Research Grant; Significant; Steatlh Biotherapeutics, Servier. Speakers Bureau; Significant; AMGEN, Relypsa. Consultant/Advisory Board; Modest; Gilead, IC Therapeutics, Faraday Pharmaceutics. Consultant/Advisory Board; Significant; Pfizer. R.P. Giugliano: Research Grant; Significant; Daiichi-Sankyo. Honoraria; Significant; Daiichi-Sankyo, American College of Cardiology. Consultant/Advisory Board; Modest; Boehering Ingelheim, Bristol Myers Squibb, Merck, Portola, Pfizer. Consultant/Advisory Board; Significant; Daiichi-Sankyo, Lexicon. W.D. Weaver: Honoraria; Significant; Stealth BioTherapeutics. J. Carr: Employment; Significant; Stealth BioTherapeutics. N. Michalak: None. G. Chi: None. M. Villarreal: None. A. Gallo: None. D. Szlosek: None. P. Jain: None. L. Rusowicz-Orazem: None. C.M. Gibson: Research Grant; Significant; Angel Medical Corporation, Bayer Corp, CSL Behring, Ikaria, Inc, Janssen Pharmaceuticals, Inc, Johnson & Johnson Corp, Portola Pharmaceuticals, Stealth BioTherapeutics, St. Jude’s Medical. Other Research Support; Modest; The Medicines Company. Honoraria; Modest; Boston Clinical Research Institute, Cardiovascular Research Foundation, Eli Lilly and Company, Gilead Sciences, Inc, Novo Nordisk Inc, Pfizer, St. Jude Medical Corp, The Medicines Company, WebMD.
- © 2016 by American Heart Association, Inc.