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Prognosis in diabetic patients with acute myocardial infarction treated invasively is related to renal function

Jacek Kowalczyk1, Radoslaw Lenarczyk, Krzysztof Strojek

  • 1Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland. jacekmed@yahoo.com

Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
|January 30, 2010
PubMed

Insights

Diabetes with chronic kidney disease (CKD) significantly worsens outcomes for acute myocardial infarction (AMI) patients. However, diabetes without CKD does not impact prognosis after AMI, suggesting renal status is key for diabetic patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology

Background:

  • Increasing prevalence of diabetes mellitus (DM) and chronic kidney disease (CKD).
  • DM and CKD are significant risk factors for cardiovascular complications.
  • Evaluating the impact of DM with and without CKD on prognosis in acute myocardial infarction (AMI) patients.

Purpose of the Study:

  • To assess the prognostic impact of type 2 diabetes mellitus (DM) in patients with acute myocardial infarction (AMI).
  • To differentiate the outcomes of diabetic patients with coexisting chronic kidney disease (CKD) versus those without CKD.
  • To compare the prognosis of diabetic AMI patients with CKD, diabetic AMI patients without CKD, and non-diabetic AMI patients.

Main Methods:

  • Single-center prospective study of 3334 AMI patients without cardiogenic shock.
  • Patients categorized into: Type 2 DM (n=999) and non-diabetics (n=2335).
  • Diabetic patients further classified into: DM with CKD (DM-CKD, n=264) and DM without CKD (DM-nCKD, n=735).
  • Outcomes compared using multivariate Cox-regression analysis to identify independent predictors of mortality and composite endpoints.

Main Results:

  • DM patients exhibited higher mortality rates across all observation periods compared to non-diabetics (nDM).
  • DM-CKD patients had significantly higher total mortality (35.6%) than DM-nCKD (11.6%) and nDM (9.8%) groups (P<0.001).
  • Mortality and major adverse cardiovascular event rates were similar between DM-nCKD and nDM groups.
  • Diabetes with CKD emerged as a strong independent risk factor for death (HR 1.93; P<0.001).

Conclusions:

  • Prognosis in diabetic AMI patients is critically dependent on renal function.
  • Diabetic patients without CKD demonstrated a similar prognosis to non-diabetic patients post-AMI.
  • Diabetes with CKD, but not diabetes alone, is an independent risk factor for adverse cardiovascular outcomes and mortality in AMI patients.
Abstract

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