Abstract 3688: The Impact Of Cardio-renal Syndrome And Diabetes Mellitus On The Future Cardiac Events After The Onset Of Acute Myocardial Infarction
Background: Recently, renal dysfunction (RD)/chronic kidney disease (CKD) has been reported to have a close relation with future cardiac events (CE) in the primary prevention settings, but few have investigated an association between RD and CE in patients after acute myocardial infarction (AMI). Especially, there are few reports concerning the impact of diabetes mellitus (DM) in patients with RD after AMI.
Methods: To investigate the impact of RD (glomerular filtration rate (GFR) < 60ml/min/1.73m2) and DM after AMI, we investigated 3,582 AMI patients (mean age 66.3, Male 2,661(74.3%)) registered to the Osaka Acute Coronary Insufficiency Study from January 2000 to June 2006 for a mean follow-up period of 517 days. We used the Modification of Diet in Renal Disease (MDRD) equation for Japanese to estimate GFR.
Results: First, RD was associated with high age, the prevalence of female, hypertension, heart failure (Killip ≥ 2) and high levels of serum hsCRP, but neither with the prevalence of DM nor peak CK levels after MI. In the univariate analysis, patients with RD had a higher rate of all cause mortality (16.9% vs. 3.7%), cardiac death (9.9% vs. 1.9%) and death due to heart failure (6.0% vs. 0.5%) compared with patients without RD (p < 0.001). Next, we classified the patients into four groups; control group (DM(−) and RD(−)), DM group (DM(−) and RD(−)), RD group (DM(−) and RD(+)) and DM/RD group (DM(+) and RD(+)) by the presence of RD or DM. Compared with Control and DM groups, RD and DM/RD groups had higher incidence of all cause mortality (3.4%, 3.8%, 13.9% and 18.2%, respectively), cardiac death(1.5%, 2.2%, 8.6% and 9.3%) and death due to heart failure(0.3%, 0.9%, 5.3% and 7.1%) with statistical significance(p<0.001), suggesting that DM was not associated with worse prognosis in the absence of RD. Indeed, Cox regression analysis revealed that DM was a predictor for re-infarction (Hazard Ratio (HR) 2.09, p=0.014) and heart failure (HR 2.08, p=0.004) in patients with RD, but not in those without.
Conclusions: RD was significantly associated with all cause mortality and cardiac events including cardiac death and death due to heart failure after AMI. Furthermore, DM seemed to influence future cardiac events after AMI in the presence of RD.