ObjectiveTo investigate the relationship between admission serum potassium level and long-term prognosis in patients with unstable angina. MethodsWe studied the data of 1 412 patients with unstable angina who received coronary angiography examinations and completed the follow-up between July 2008 and September 2012. Serum potassium level within the first 24 hours after admission was collected. According to the serum potassium level, the patients were divided into three groups:those with a serum potassium level lower than 3.5 mmol/L, those with a level between 3.5 and 5.0 mmol/L and those with a level higher than 5.0 mmol/L. Then, we analyzed the relationship between admission serum potassium level and long-term prognosis in patients with unstable angina. ResultsThere was a U-shaped relationship between admission serum potassium level and long-term mortality that persisted after multivariable adjustment in patients with unstable angina. The all-cause mortality risk was the lowest in the group of patients with a potassium level of 3.5 to 5.0 mmol/L, whereas mortality was higher in patients with potassium level lower than 3.5 mmol/L and higher than 5.0 mmol/L [HR=1.89, 95%CI (1.13, 3.17), P=0.016; HR=1.64, 95%CI (0.40, 6.77), P=0.493]. Compared with patients with a serum potassium level between 3.5 and 5.0 mmol/L, the cardiovascular mortality risk was significantly higher in those patients with a potassium level lower than 3.5 mmol/L [HR=1.99, 95%CI (1.01, 3.94), P=0.048]. ConclusionThere is a U-shaped relationship between admission serum potassium level and long-term all-cause mortality rate, and the all-cause mortality rate and cardiovascular mortality risk was the lowest in patients with a potassium level between 3.5 and 5.0 mmol/L.
VNS can achieve a stable reduction in seizure frequency across different DRE populations, with a well-documented time-dependent cumulative therapeutic effect, while complete seizure freedom is rarely achieved in patients. Compared with low-intensity stimulation, high-intensity stimulation significantly increased the probability of achieving ≥50% seizure reduction (RR=1.73). For pediatric DRE, systematic reviews and meta-analyses revealed that approximately 55% of patients achieved significant seizure reduction (≥50%), and the overall response rate reached around 68% in DRE cases with genetic etiologies. Real-world studies indicated that the cumulative rate of ≥12-month complete seizure freedom was approximately 11%, whereas the cumulative rate of ≥12-month freedom from tonic-clonic seizures reached up to 54.9%; moreover, seizure-free status was closely correlated with improved quality of life. In terms of safety profile, common stimulation-related adverse events included voice alteration/hoarseness, cough, and dyspnea, most of which were tolerable. Summaries of long-term clinical experience showed that the incidence of surgery-related complications was approximately 8.6%, and that of hardware-related complications was around 3.7%. Infection, hematoma, vocal cord paralysis, and lead malfunction were the key events requiring priority prevention and control.VNS is an important neuromodulatory treatment option for DRE, especially for patients who are ineligible for resective surgery or have persistent seizures after surgery, with a favorable overall tolerability profile. However, its ability to achieve long-term complete seizure freedom remains limited. Standardized long-term follow-up and individualized programming (including closed-loop strategies and parameter optimization) are expected to further enhance clinical benefits. Future research should focus on stratification by etiology/network phenotype, standardization of core outcome measures, external validation of translatable predictive biomarkers, as well as prospective controlled studies on key programming strategies and combined treatment pathways.