Abstract
Background: Prognostic factors for acute myocardial infarction include diabetes mellitus and renal impairment (AMI). Few studies, meanwhile, have examined the impact of renal insufficiency in the setting of diabetes and AMI. Here, we looked into the clinical outcomes for individuals with AMI who also had a renal impairment and diabetes mellitus.
Method: 400 AMI patients (62 ± 12 years; 71% men) were included in this study from November 2021 to August 2022 and divided into 4 groups as follows: Group I (n = 100) did not have either diabetes nor renal insufficiency (glomerular filtration rate [GFR] 50 ml/min/1.72m2), Group II (n = 100) did not have either condition, Group III (n = 100) did not have either condition but did have renal insufficiency, and Group IV (n = 100) did. Major adverse cardiac events (MACE), which included a composite of all causes of mortality, myocardial infarction, target lesion revascularization, and coronary artery bypass graft after one year of clinical follow-up, were the main objectives.
Results: 180 (18.1%) patients experienced the primary objectives. In terms of composite MACE, there were differences between the 4 groups that were statistically significant (Group I: 12.4%; Group II: 15.6%; Group III: 30.4%; Group IV: 36.6%; p <0.002). The 12-month mortality increased stepwise from Group III to IV as compared with Group I in a Cox proportional hazards model after multiple covariates were taken into account (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.33-2.85; p = 0.002; and HR, 2.41; 95% CI, 1.61-3.61; p <0.002, respectively). However, Kaplan-Meier analysis found no significant difference between Group III and IV in the chance of mortality at 1 year (p = 0.287).
Conclusion: Composite MACE is linked to renal insufficiency, particularly when it occurs in conjunction with diabetes, and implies a bad prognosis in individuals with AMI. Patients who have diabetes and/or renal insufficiency are classified, which is useful data for early risk stratification of AMI patients.

Key words: renal insufficiency, diabetes mellitus, severe adverse cardiac events, and acute myocardial infarction