Impact of chronic kidney disease and diabetes mellitus on the prognosis in patients with acute myocardial infarction

Introduction：This study aimed to explore the combined impact of diabetes mellitus (DM) and chronic kidney disease (CKD) on short-term and long-term all-cause mortality in patients with acute myocardial infarction (AMI). Methods：This is a prospective cohort AMI registry conduced in Cardiology Division of Cardiovascular Medical Center in Far Eastern Memorial Hospital which is located in New Taipei City, Taiwan. Database are constructed by the study coordinators and nurse practitioners according to medical records, and quality control by a cardiologist is performed every month. The primary endpoint is follow-up all-cause mortality. The data stratified by CKD and DM, univariate analysis and Cox proportional hazards model were used to evaluate the impacts in 30-day, 1- and 2-year all-cause mortality. Result：Between 2005 and 2013, a total of 2259 AMI patients were recruited. Mean follow-up duration was 1.69 ± 0.23 years. In the univariable analysis, the hazard ratio（HR）for CKD was 2.11 (95% confidence interval (CI) 1.66-2.69) in 30-day, and 6.07 (95% CI 4.67-7.92) in 2-year all-cause mortality. As for DM, HR was 1.81（95% CI 1.33-2.46）in 30-day, and 6.07（95% CI 4.67-7.92）in 2-year all-cause mortality (all P<0.05). Other prognostic factors including smoking, hypertension, atrial fibirllaiton, history of coronary artery disease or stroke, all reached statistical significance. Subjects with either CKD or DM had significantly higher risk of all-cause mortality than who without. Cox proportional hazards model showed significantly higher adjusted HRs of CKD only, or with DM and CKD were 2.22 (95% confidence interval (CI) 1.43-3.44) and 3.34 (95% CI 2.17-5.13), respectively, compared to subjects with neither DM and CKD, or DM only. Our findings support a positive association with CKD in short-term and long-term prognosis in patients with AMI. Conclusion：This study confirmed that CKD, rather than DM, is a strong prognostic factor in short-term and long-term all-cause mortality in AMI.