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RESEARCH PRODUCT

Chronic Kidney Disease, Diabetes, and Risk of Mortality After Acute Myocardial Infarction: Insight From the FAST-MI Program

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Diabetes is associated with a substantially increased risk of all-cause death, mainly driven by cardiovascular (CV) mortality. Furthermore, diabetes is associated with poorer outcomes after acute myocardial infarction (AMI) (1). Impaired glomerular filtration rate (GFR) is also associated with an increased risk of CV mortality (2). However, whether diabetes still confers a higher risk of mortality in patients with impaired GFR remains unknown. The aim of this study was to assess the long-term prognostic significance of both diabetes and renal impairment in two prospective nationwide cohorts of AMI patients: FAST-MI (French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction) 2005 ( n = 3,670 [reg. no. NCT00673036, ClinicalTrials.gov]) and FAST-MI 2010 ( n = 4,169 [NCT01237418]) (3). Both registries consecutively included patients with AMI admitted to cardiac intensive care units within 48 h of symptom onset during a specified 1-month period. AMI was defined by increased levels of cardiac biomarkers together with either compatible symptoms or electrocardiogram changes. Vital status at 5 years was available in >95%. We assessed all-cause mortality at 5 years according to estimated GFR (eGFR) (calculated with Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] formula and based on KDIGO [Kidney Disease: Improving Global Outcomes] GFR categories with eGFR <30 and <15 mL/min/1.73 m2 pooled) and diabetes status at inclusion. Multivariable proportional hazards models (assumptions checked) were used with covariates chosen based on their potential prognostic relevance: year of inclusion; sex; age; BMI categories; hypertension; current smoking; prior AMI; peripheral artery disease; history of heart failure, stroke, cancer, and chronic obstructive pulmonary disease; type of myocardial infarction (MI) (STEMI or NSTEMI); GRACE risk score; percutaneous coronary …