Prognosis in diabetic patients with acute myocardial infarction treated invasively is related to renal function
Jacek Kowalczyk, Radoslaw Lenarczyk, Krzysztof Strojek, Teresa Zielinska, Janusz Gumprecht, Agnieszka Sedkowska, Tomasz Kukulski, Marcin Swierad, Oskar Kowalski, Beata Sredniawa, Lech Polonski, Marian Zembala, Zbigniew Kalarus
Med Sci Monit 2010; 16(2): CR67-74
Available online: 2010-02-01
The prevalence of diabetes mellitus (DM) and chronic kidney disease (CKD) is rapidly increasing. Both comorbidities are considered significant risk factors for cardiovascular complications. The aim of the study was to evaluate the impact of DM with and without CKD on prognosis in patients with acute myocardial infarction (AMI) treated invasively.
Material and Method: This single-center prospective study encompassed 3334 AMI-patients without cardiogenic shock, who were divided into 2 major groups: 999 patients with type 2 DM diagnosed prior to or during index hospitalization, and 2335 non-diabetics. All diabetic patients were divided with respect to their renal status into: diabetics with CKD (DM-CKD; n=264) and without (DM-nCKD; n=735). Short- and long-term outcomes were compared between study groups. Independent predictors of death and composite end-point were selected with multivariate Cox-regression model.
Results: Mortality rates were significantly higher in DM group compared to nDM in all observation periods. DM-CKD was associated with excessive total mortality (35.6%) when compared to DM-nCKD (11.6%, P<0.001) and to nDM (9.8%, P<0.001). Mortality and major adverse cardiovascular event rates did not differ significantly between DM-nCKD and nDM groups. Diabetes coexisting with CKD was one of the strongest independent risk factors for death (hazard ratio 1.93; confidence interval 1.79-2.07; P<0.001).
Conclusions: The prognosis in diabetics with AMI is significantly related to renal function. Diabetics without CKD had similar prognosis to non-diabetics. Multivariate analyses showed that unlike diabetes without renal dysfunction, DM-CKD was an independent risk factor for cardiovascular complications and total mortality.
Keywords: Risk Factors, Time Factors, Proportional Hazards Models, Prognosis, Myocardial Infarction - therapy, Kidney Function Tests, Kaplan-Meier Estimate, Diabetes Complications - therapy, Demography