Prognostic impact of diabetes mellitus on in-hospital mortality in patients with acute myocardial infarction complicating renal dysfunction according to age and sex

IF 2.7 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Hellenic Journal of Cardiology Pub Date : 2025-03-01 DOI:10.1016/j.hjc.2023.11.002

Kenichi Matsushita , Sunao Kojima , Kyoko Hirakawa , Noriaki Tabata , Miwa Ito , Kenshi Yamanaga , Koichiro Fujisue , Tadashi Hoshiyama , Shinsuke Hanatani , Daisuke Sueta , Hisanori Kanazawa , Seiji Takashio , Yuichiro Arima , Satoshi Araki , Hiroki Usuku , Satoru Suzuki , Eiichiro Yamamoto , Taishi Nakamura , Hirofumi Soejima , Koichi Kaikita , Kenichi Tsujita

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Abstract

Background

Patients with acute myocardial infarction (AMI) complicating renal dysfunction (RD) are recognized as being at high risk. Although diabetes mellitus (DM) is a major cause of RD, the prognostic impact of coexisting DM on mortality in patients with AMI complicating RD is ill-defined. This study compared the prognostic impact of coexisting DM in patients with AMI complicating RD according to both age and sex.

Methods

A multicenter retrospective study was conducted on 2988 consecutive patients with AMI complicating RD (estimated glomerular filtration rate <60 mL/min per 1.73 m²). Multivariable Cox regression analysis was performed to investigate the effects of DM on in-hospital mortality.

Results

Statistically significant interactions between age and DM and between sex and DM for in-hospital mortality were revealed in the entire cohort. Coexisting DM was identified as an independent risk factor for in-hospital mortality (hazard ratio [HR], 2.543) in young (aged <65 years), but not old (aged ≥65 years), patients. DM was identified as an independent risk factor (HR, 1.469) in male, but not female, patients. Kaplan–Meier survival curves showed that DM correlated with significantly low survival rates in patients that were young or male as compared to those who were old or female.

Conclusions

There were significant differences in the prognostic impact of DM on in-hospital mortality between young and old as well as male and female patients with AMI complicating RD. These results have implications for future research and the management of patients with DM, RD, and AMI comorbidities.

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糖尿病对急性心肌梗死合并肾功能不全患者住院死亡率的影响与年龄、性别的关系

背景:急性心肌梗死(AMI)并发肾功能不全(RD)是公认的高危患者。虽然糖尿病(DM)是RD的主要原因，但合并AMI并发RD患者的DM对死亡率的预后影响尚不明确。本研究根据年龄和性别比较了AMI合并RD患者并发DM对预后的影响。方法:对2988例AMI合并RD患者(估计肾小球滤过率< 60 mL/min / 1.73 m2)进行多中心回顾性研究。采用多变量Cox回归分析探讨糖尿病对住院死亡率的影响。结果:在整个队列中，年龄和糖尿病之间以及性别和糖尿病之间的相互作用对住院死亡率有统计学意义。合并糖尿病被确定为年轻(年龄< 65岁)患者住院死亡率的独立危险因素(危险比[HR]， 2.543)，但不是老年(年龄≥65岁)患者住院死亡率的独立危险因素。糖尿病被认为是男性患者的独立危险因素(HR, 1.469)，而女性患者则不是。Kaplan-Meier生存曲线显示，与老年或女性患者相比，年轻或男性患者的DM与显著较低的生存率相关。结论:糖尿病对院内死亡率的预后影响在年轻和老年以及男性和女性AMI合并RD患者之间存在显著差异。这些结果对未来的研究和DM、RD和AMI合并症患者的管理具有重要意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hellenic Journal of Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

7.30%

发文量

审稿时长

56 days

期刊介绍： The Hellenic Journal of Cardiology (International Edition, ISSN 1109-9666) is the official journal of the Hellenic Society of Cardiology and aims to publish high-quality articles on all aspects of cardiovascular medicine. A primary goal is to publish in each issue a number of original articles related to clinical and basic research. Many of these will be accompanied by invited editorial comments. Hot topics, such as molecular cardiology, and innovative cardiac imaging and electrophysiological mapping techniques, will appear frequently in the journal in the form of invited expert articles or special reports. The Editorial Committee also attaches great importance to subjects related to continuing medical education, the implementation of guidelines and cost effectiveness in cardiology.