FREQUENCY OF HYPONATREMIA AND ITS SHORT TERM CLINICAL OUTCOMES AFTER ACUTE ST ELEVATION MYOCARDIAL INFARCTION

Objective: To determine the frequency of hyponatremia and its short term clinical outcomes after acute ST-elevation myocardial infarction. Methodology: This cross sectional study was conducted at Department of Cardiology, Lady Reading Hospital Peshawar from 1st November 2014 to 30th April 2015. Patients of either gender aged between 18 to 60 years admitted with acute ST elevation myocardial infarction were included in the study. Serum sodium was measured in all patients at admission, 24 hrs, 48 hrs and 72 hrs post admission to detect hyponatremia. All hyponatremic patients were followed during their hospital stay for in hospital mortality, acute heart failure and cardiogenic shock. P value of less than 0.05 was taken as significant. Results: The total numbers of patients were 159. Mean age was 51.8 +/- 7.2 (18-60) yrs. Males were 70.4% (n=112). Mean serum sodium was 138 +/- 6.8 mmol/L. Of the total 47.2% (75) were hypertensive. Diabetes was found in 28.3% (45) of study population. 37.1% (59) were smoker. Dyslipidemia was found in 32.1% (51). 18.9% (30) patients were having obesity. Hyponatremia (serum sodium <= 135mmol/L) was present in 22% (n =35) patients. Hyponatremia was equally common in male and female patients (21.4% vs 23.4%). Sub group analyses revealed a higher but statistically insignificant hyponatremia in patients with anterior MI and of older age. Of 35 hyponatremic patients all were followed during their hospital stay for in-hospital outcomes. In hospital mortality noted in these patients was 48.6% (p=0.001). Acute heart failure was in 60% of hyponatremic patients (p=0.001). Cardiogenic shock was in 54.3% of patients (p= 0.001). Conclusions: Hyponatremia in hospitalized patients with acute ST elevation myocardial infarction is relatively common and is associated with higher inhospital and early post-discharge mortality.