title: The impact of stage of chronic kidney disease on the outcomes of diabetics with acute myocardial infarction treated with percutaneous coronary intervention.
abstract: BACKGROUND
  Patients with diabetes mellitus (DM) or chronic kidney disease (CKD) have a high risk of acute myocardial infarction and recurrent cardiovascular events. According to the previous studies, the combination of the two conditions may have a synergistic impact on prognosis. The aim of this study was to assess the impact of stage of CKD on the outcomes of patients with DM and ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI).
  
  
  METHODS
  Study population consisted of 946 consecutive patients with STEMI who underwent PCI from January 2009 to December 2012 and were followed up until the end of 2013. The all-cause mortality during this period was evaluated in relation to DM and severe or moderate reduction in glomerular filtration rate (GFR categories G4-5, or G3; KDIGO classification). Cox regression analysis adjusted for possible confounding factors was used in statistics.
  
  
  RESULTS
  Out of the study population (mean age 63 years, 69.6 % males), 217 (22.9 %) patients had DM. Of them, 10.6 % were in GFR category G4-5 and 32.7 % in G3. The in-hospital mortality rates in patients with DM were 34.8 % for G4-5, 18.3 % for G3, and 4.1 % in G1-2 groups. The all-cause mortality at the end of the follow-up period for diabetics within G4-5 was 2.27 -times higher compared to mortality of diabetics in G1-2 (p = 0.047, Cox regression analysis), and there was a trend toward higher mortality for G3 versus G1-2 (HR 1.64, p = 0.12).
  
  
  CONCLUSIONS
  Severe chronic kidney disease (GFR category 4-5) was significantly associated with all-cause mortality of diabetics with STEMI treated with PCI; the association with severe CKD was stronger compared to moderate CKD.
authors.affiliation: Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic.
authors.forename: Teodora
authors.initials: T
authors.lastname: Vichova
authors.affiliation: Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Knot
authors.affiliation: Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Ulman
authors.affiliation: Department of Biostatistics and Informatics, National Institute of Public Health, Srobarova 48, 10042, Prague, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Maly
authors.affiliation: Cardiocentre, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 10034, Prague, Czech Republic. motovska.zuzana@gmail.com.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Motovska
mesh_terms: D017677:Age Distribution; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis
keywords: Chronic kidney disease; Diabetes mellitus; Mortality; PCI; STE myocardial infarction