Concomitant renal insufficiency and diabetes mellitus as prognostic factors for acute myocardial infarction

Title
Concomitant renal insufficiency and diabetes mellitus as prognostic factors for acute myocardial infarction
Author(s)
김영조김창성[김창성]최준석[최준석]박정우[박정우]배은희[배은희]마성권[마성권]정명호[정명호]조명찬[조명찬]김종진[김종진]김수완[김수완]
Keywords
ACUTE CORONARY SYNDROMES; CHRONIC-HEMODIALYSIS PATIENTS; CARDIOVASCULAR-DISEASE; SERUM CREATININE; HEART-DISEASE; RISK-FACTORS; MORTALITY; DYSFUNCTION; NEPHROPATHY; OUTCOMES
Issue Date
201110
Publisher
BIOMED CENTRAL LTD
Citation
CARDIOVASCULAR DIABETOLOGY, v.10
Abstract
Background: Diabetes mellitus and renal dysfunction are prognostic factors after acute myocardial infarction (AMI). However, few studies have assessed the effects of renal insufficiency in association with diabetes in the context of AMI. Here, we investigated the clinical outcomes according to the concomitance of renal dysfunction and diabetes mellitus in patients with AMI. Methods: From November 2005 to August 2008, 9905 patients (63 +/- 13 years; 70% men) with AMI were enrolled in a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR) and were categorized into 4 groups: Group I (n = 5700) had neither diabetes nor renal insufficiency (glomerular filtration rate [GFR] >= 60 ml/min/1.73 m(2)), Group II (n = 1730) had diabetes but no renal insufficiency, Group III (n = 1431) had no diabetes but renal insufficiency, and Group IV (n = 1044) had both diabetes and renal insufficiency. The primary endpoints were major adverse cardiac events (MACE), including a composite of all cause-of-death, myocardial infarction, target lesion revascularization, and coronary artery bypass graft after 1-year clinical follow-up. Results: Primary endpoints occurred in 1804 (18.2%) patients. There were significant differences in composite MACE among the 4 groups (Group I, 12.5%; Group II, 15.7%; Group III, 30.5%; Group IV, 36.5%; p < 0.001). In a Cox proportional hazards model, after adjusting for multiple covariates, the 1-year mortality increased stepwise from Group III to IV as compared with Group I (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.34-2.86; p = 0.001; and HR, 2.42; 95% CI, 1.62-3.62; p < 0.001, respectively). However, Kaplan-Meier analysis showed no significant difference in probability of death at 1 year between Group III and IV (p = 0.288). Conclusions: Renal insufficiency, especially in association with diabetes, is associated with the occurrence of composite MACE and indicates poor prognosis in patients with AMI. Categorization of patients with diabetes and/or renal insufficiency provides valuable information for early-risk stratification of AMI patients.
URI
http://hdl.handle.net/YU.REPOSITORY/24449http://dx.doi.org/10.1186/1475-2840-10-95
ISSN
1475-2840
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의과대학 > 내과학교실 > Articles
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