MO727: Acute Myocardial Infarction in Diabetic Versus Non-Diabetic Haemodialysis Patients: A Single Centre 4-Years’ Experience
Authors: Silva Rita , Castro Pedro , Lança Alice , Romãozinho Catarina , Alves Rui 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Cardiovascular disease (CVD) is the leading cause of death among patients with end-stage renal disease accounting for 40% of all mortality. Diabetes mellitus, the main cause of chronic kidney disease (CKD) worldwide, together with obesity, hypertension and dyslipidaemia, places patients at higher risk for acute myocardial infarction (AMI). Effective treatment such as coronary revascularization is critical to lowering the subsequent risk of CV events and improving long-term survival. In this study, we aim to compare the cardiovascular outcomes in diabetic versus non-diabetic patients in dialysis following an AMI.

Methods
We retrospectively enrolled 70 CKD stage 5d patients (4 h/3 times a week) aged ≥ 18 years old who were admitted at the cardiac intensive care unit with AMI between January 2017 and December 2020. Baseline variables and laboratory data were collected at admission and 1 month after discharge for follow-up. Two groups were created: G1 (diabetic) and G2 (non-diabetic). Data were collected by consulting electronic medical records. Statistical analyses were performed using the SPSS statistics version 23.0.

RESULTS
Seventy patients (male: 72.9%) with a mean age of 70.9 ± 12 years were selected. G1 (n = 33; 47.1%) and G2 (n = 37; 52.1%) had similar distributions of gender (male: 72.7% versus 72.9%; P = 0.081) and age (70.9 ± 9 versus 70.8 ± 10 years; P = 0.076) opposite to dialysis vintage (33 versus 17 months; P = 0.003). The main CKD cause in G2 was hypertensive nephrosclerosis (n = 14, 37.8%), followed by uncertain aetiology (n = 10, 27.1%), obstructive uropathy (n = 6, 16.2%), autosomal dominant polycystic kidney disease (n = 3, 8.1%), IgA nephropathy (n = 2, 5.4%) and small vessel vasculitis (n = 2, 5.4%). Previous comorbidities were (G1 versus G2): arterial hypertension (93.9% versus 97.3%; P = 0.77), smoking habits (9.1% versus 16.2%; P = 0.033), heart failure (78.8% versus 67.6%; P = 0.064), left ventricular hypertrophy (47.9% versus 52.8%; P = 0.082), body mass index &gt; 30 kg/m2 (57.6% versus 56.8%; P = 0.72) and dyslipidaemia (100% versus 99%; P = 0.91). At admission, groups were compared hypoalbuminemia (serum albumin &lt; 3.0 g/dL) [37.9% versus 26.8%, OR 4.1, 95% confidence interval (95% CI) 2.1–24.4; P = 0.0022] and clinical frailty score &gt; 4 points (56 versus 32%, OR 5.4, 95% CI 1.4–25.1, P = 0.0041). Total cholesterol (149 ± 38 versus 146 ± 39 mg/dL) and low-density lipoprotein cholesterol (97 ± 31.6 versus 94 ± 29.9 mg/dL) were also compared with no statistically significant differences. In G1, glycaemic control was satisfactory (HbA1c: 7.4%); 45.5% (n = 15) were taking insulin alone, 9.0% (n = 3) were taking oral antidiabetics (DPP-4 inhibitors) and 45.5% (n = 15) were using a combined therapy. Regarding AMI in G1 and G2, ST segment elevation myocardial infarction (STEMI) was present in 8 (24.2%) versus 11 (29.7%) patients (P = 0.08); all patients underwent coronary revascularization except 3 patients on each group (9% versus 8.1%), who had a NSTEMI. During hospitalization (10.5 ± 6 days versus 10.2 ± 12 days; P = 0.12), 13 patients died (n = 6; 18.2% versus n = 7; 18.9%, P = 0.07); 3 were treated conservatively and all 3 belonged to G1. The main cause of death was cardiogenic shock (n = 10, 83.3%). No deaths or new CV events occurred 30 days post-AMI. Multiple regression analysis showed that dialysis vintage was the only significant predictor for the occurrence of a CV event, regardless of being STEMI/NSTEMI or of any intervention.

CONCLUSION
Based on our results, G1 and G2 showed no difference in mortality or risk of developing a new CV event in the following month post-AMI. This might be related with several non-traditional risk factors, such as chronic volume overload, anaemia, inflammation, oxidative stress, and chronic kidney disease-mineral bone present in the majority of dialysis patients that were not evaluated or with the size of our sample.