Prognosis After First-Ever Myocardial Infarction in Type 1 Diabetes Is Strongly Affected by Chronic Kidney Disease

• Published in: Diabetes care Vol. 46; no. 1; pp. 197 - 205
• Main Authors: Smidtslund, Patrik, Jansson Sigfrids, Fanny, Ylinen, Anni, Elonen, Nina, Harjutsalo, Valma, Groop, Per-Henrik, Thorn, Lena M
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01-01-2023
• Subjects: Cardiovascular and Metabolic Risk; Cardiovascular disease; Cardiovascular diseases; Congestive heart failure; Coronary artery disease; Death; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - complications; Diabetic nephropathy; Failure analysis; Follow-Up Studies; Glomerular filtration rate; Health risks; Heart attacks; Heart diseases; Heart failure; Heart Failure - complications; Humans; Kidney diseases; Kidneys; Medical prognosis; Medical records; Mortality; Myocardial infarction; Myocardial Infarction - complications; Nephropathy; Prognosis; Renal failure; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Research design; Risk analysis; Risk Factors
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc22-1586

To study prognosis after a first-ever myocardial infarction (MI) in type 1 diabetes, as well as how different MI- and diabetes-related factors affect the prognosis and risk of secondary cardiovascular events.
In this observational follow-up study of 4,217 individuals from the Finnish Diabetic Nephropathy (FinnDiane) Study with no prior MI or coronary revascularization, we verified 253 (6.0%) MIs from medical records or death certificates. Mortality from cardiovascular or diabetes-related cause was our main end point, whereas hospitalization due to heart failure, coronary revascularization, and recurrent MI were secondary end points, while accounting for death as a competing risk.
Of the individuals studied, 187 (73.9%) died during the median post-MI follow-up of 3.07 (interquartile range 0.02-8.45) years. Independent risk factors for cardiovascular and diabetes-related mortality were estimated glomerular filtration rate categories grade 3 (G3) (hazard ratio [HR] 3.27 [95% CI 1.76-6.08]), G4 (3.62 [1.69-7.73]), and G5 (4.03 [2.24-7.26]); prior coronary heart disease diagnosis (1.50 [1.03-2.20]); and older age at MI (1.03 [1.00-1.05]). Factors associated with lower mortality were acute revascularization (HR 0.35 [95% CI 0.18-0.72]) and subacute revascularization (0.39 [0.26-0.59]). In Fine and Gray competing risk analyses, kidney failure was associated with a higher risk of recurrent MI (subdistribution HR 3.27 [95% CI 2.01-5.34]), heart failure (3.76 [2.46-5.76]), and coronary revascularization (3.04 [1.89-4.90]).
Individuals with type 1 diabetes have a high cardiovascular and diabetes-related mortality after their first-ever MI. In particular, poor kidney function is associated with high mortality and excessive risk of secondary cardiovascular events.