Potassium Levels After Acute Myocardial Infarction

To the Editor: Dr Goyal and colleagues¹ reconfirmed poorer outcomes in patients with dyskalemia presenting with AMI. Although the authors correctly suggested that routine potassium supplementation is unwarranted in this setting, I believe that the clinical applicability of their findings and their implications for practice are limited.

The authors of the study¹ and the accompanying editorial² overstated potassium supplementation guidance in the setting of AMI.^3- 5 The guidelines from the American College of Cardiology and the American Heart Association⁴ address potassium only in the context of angiotensin-aldosterone axis antagonism and refractory or recurrent ventricular dysrhythmias. Routine potassium supplementation was not advised. An industry-sponsored conference report³ was referenced, which did not recommend routine potassium supplementation. Additionally cited were generic recommendations for the maintenance of higher serum potassium levels⁵ based on a nonrigorous analysis of favorable epidemiological associations with both higher dietary potassium intake and serum potassium levels. The independent contributions of potassium levels and pharmacological interventions that influence potassium homeostasis were not fully considered. Taken together, these recommendations seem too weak to support routine potassium supplementation in the setting of AMI.