Comparison of two-year clinical outcomes according to glycemic status and renal function in patients with acute myocardial infarction following implantation of new-generation drug-eluting stents

In a sub-study of the ACCORD trial, it was found that T2DM patients with complaints of CKD had an increased risk of CVD as compared to DM patients without CKD. However, there are limited studies focusing on the comparative clinical outcomes between prediabetes and T2DM, especially in the acute myocardial infarction (AMI) and history of CKD. Yong Hoon Kim and colleagues conducted research under the title “Comparison of two-year clinical outcomes according to glycemic status and renal function in patients with acute myocardial infarction following implantation of new-generation drug-eluting stents” published in the Journal of Diabetes and Its Complications. The summary of this study is given below:

Objective:

To compare the two-year clinical outcomes between prediabetes and T2DM in patients with AMI and CKD.

Method:

A total of 11,961 AMI patients were included in the study. They were classified into group A (estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73m2) and group B (eGFR ≥60 ml/min/1.73 m2). These 2 groups were sub-categorized into normoglycemia, prediabetes, and T2DM. The presence of major adverse cardiac events (MACE), defined as all-cause death, recurrent MI (re-MI), and any repeat revascularization was investigated.

Findings:

No significant difference was observed in major clinical outcomes in patients with AMI and CKD between prediabetes and T2DM. On the other side, subjects in pre-diabetes and T2DM groups revealed a higher mortality rate than the normoglycemia group regardless of the degree of eGFR. Moreover, the progressive incidences of MACE, CD, and all-cause death were significantly higher in group A than those in all three glycemic subgroups of group B. The study encourages large-scale long-term prospective randomized studies for the future.

Limitation:

Due to the non-randomized nature of the study, there are chances of some under-reporting and/or missed data, and selection bias. Secondly, while longer exposure to hyperglycemia might increase the risk of CKD; these registry data did not include this variable. Thirdly, there are chances of some misclassification of study groups as there was a lack of information concerning the total amount of proteinuria and the status of microalbuminuria. Fourth, eGFR was the only parameter for the estimation of renal function. There is a chance of this being affected by the hemodynamic or metabolic status of the patients. Fifth, the registry data did not include detailed information on prescription doses, discontinuation, long-term adherence, and drug-related adverse events. Investigators failed to define the degree of glycemic control of the patients during the follow-up visit, which could cause bias. Sixth, to fill the gap caused by limited HbA1c, oral glucose tolerance tests were not included to define glycemic status. Lastly, 2 year follow-up period was relatively short to conclude the long-term clinical outcomes.

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