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Impact of Cardiovascular-Kidney-Metabolic Syndrome Staging on Myocardial Infarction Outcomes: A Retrospective
Ronny Shabtai1, Marlon Villaga Gatuz2, Adam Folman2
1Adelson School of Medicine, Ariel University, Ariel 4070000, Israel.
Insights
Cardiovascular-kidney-metabolic (CKM) syndrome severity impacts acute myocardial infarction (AMI) outcomes. Advanced CKM stages increase invasive procedures, but surprisingly, patients with no CKM factors showed worse outcomes.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
- Public Health
Background:
- Cardiovascular-kidney-metabolic (CKM) syndrome integrates obesity, diabetes, chronic kidney disease, and cardiovascular disease.
- The American Heart Association recently defined CKM syndrome, highlighting its complex interrelations.
Purpose of the Study:
- To investigate the impact of CKM syndrome severity on outcomes in patients with acute myocardial infarction (AMI).
- To analyze associations between CKM stages and in-hospital procedures and outcomes in AMI patients.
Main Methods:
- Retrospective analysis of the National Inpatient Sample database (2016-2019).
- Stratification of adult AMI patients into CKM Stages 0-4 using ICD-10 codes.
- Multivariable logistic regression models to assess CKM stage associations with procedures and outcomes.
Main Results:
- Analysis of 2,768,154 AMI cases revealed associations between advanced CKM stages, older age, and male sex.
- Severe CKM stages correlated with increased likelihood of invasive procedures, including coronary angiography and PCI.
- Unexpectedly, patients with CKM Stage 0 (no CKM factors) exhibited higher odds of adverse outcomes compared to other stages.
Conclusions:
- CKM syndrome severity has a complex relationship with AMI outcomes.
- While advanced CKM stages predict higher rates of invasive procedures, Stage 0 patients faced worse outcomes.
- Further research is needed to understand the mechanisms and long-term prognosis in CKM syndrome and AMI.
Abstract:
Background: Cardiovascular-kidney-metabolic (CKM) syndrome, recently defined by the American Heart Association, encompasses the interplay between obesity, diabetes, chronic kidney disease, and cardiovascular disease. This study aimed to investigate the impact of CKM syndrome severity on outcomes in patients with acute myocardial infarction (AMI). Methods: A retrospective analysis was conducted using the National Inpatient Sample database from 2016 to 2019. Adult patients hospitalized with AMI were stratified into CKM Stages 0-4 based on ICD-10 codes. Multivariable logistic regression models were used to examine associations between CKM stages and in-hospital procedures and outcomes. Results: The study analyzed 2,768,154 AMI cases. Advanced CKM stages were associated with older age and a higher proportion of males. Patients with severe CKM were more likely to undergo invasive procedures. Coronary angiography showed the strongest association in CKM Stage 4A (aOR: 6.86, 95% CI: 6.73-6.99, p-value < 0.001) and Stage 4B (aOR: 3.87, 95% CI: 3.80-3.95, p-value < 0.001). Similarly, the likelihood of PCI was highest in Stage 4A (aOR: 5.93, 95% CI: 5.79-6.08, p-value < 0.001) and Stage 4B (aOR: 4.14, 95% CI: 4.04-4.24, p-value < 0.001). Notably, patients with CKM Stage 0 demonstrated higher odds of adverse outcomes compared to other stages. Conclusions: This study reveals a complex relationship between CKM syndrome severity and AMI outcomes. Patients with advanced CKM stages were more likely to undergo invasive procedures, and those without CKM risk factors unexpectedly showed worse outcomes. Among Stages 1-4B, no consistently graded association emerged between the CKM stage and adverse outcomes. These findings warrant further investigation into underlying mechanisms and long-term prognosis.
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