Impact of Cardiovascular–Kidney–Metabolic Syndrome Staging on Myocardial Infarction Outcomes: A Retrospective Analysis of 2.7 Million Patients

<b>Background</b>: Cardiovascular–kidney–metabolic (CKM) syndrome, recently defined by the American Heart Association, encompasses the interplay between obesity, diabetes, chronic kidney disease, and cardiovascular disease. This study aimed to investigate the impact of CKM syndrome sever...

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Main Authors: Ronny Shabtai, Marlon Villaga Gatuz, Adam Folman, Maguli S. Barel, Rami Abu-Fanne, Dmitry Abramov, Mamas A. Mamas, Ariel Roguin, Ofer Kobo
Format: Article
Language:English
Published: MDPI AG 2025-03-01
Series:Diseases
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Online Access:https://www.mdpi.com/2079-9721/13/4/97
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author Ronny Shabtai
Marlon Villaga Gatuz
Adam Folman
Maguli S. Barel
Rami Abu-Fanne
Dmitry Abramov
Mamas A. Mamas
Ariel Roguin
Ofer Kobo
author_facet Ronny Shabtai
Marlon Villaga Gatuz
Adam Folman
Maguli S. Barel
Rami Abu-Fanne
Dmitry Abramov
Mamas A. Mamas
Ariel Roguin
Ofer Kobo
author_sort Ronny Shabtai
collection DOAJ
description <b>Background</b>: Cardiovascular–kidney–metabolic (CKM) syndrome, recently defined by the American Heart Association, encompasses the interplay between obesity, diabetes, chronic kidney disease, and cardiovascular disease. This study aimed to investigate the impact of CKM syndrome severity on outcomes in patients with acute myocardial infarction (AMI). <b>Methods</b>: A retrospective analysis was conducted using the National Inpatient Sample database from 2016 to 2019. Adult patients hospitalized with AMI were stratified into CKM Stages 0–4 based on ICD-10 codes. Multivariable logistic regression models were used to examine associations between CKM stages and in-hospital procedures and outcomes. <b>Results</b>: The study analyzed 2,768,154 AMI cases. Advanced CKM stages were associated with older age and a higher proportion of males. Patients with severe CKM were more likely to undergo invasive procedures. Coronary angiography showed the strongest association in CKM Stage 4A (aOR: 6.86, 95% CI: 6.73–6.99, <i>p</i>-value < 0.001) and Stage 4B (aOR: 3.87, 95% CI: 3.80–3.95, <i>p</i>-value < 0.001). Similarly, the likelihood of PCI was highest in Stage 4A (aOR: 5.93, 95% CI: 5.79–6.08, <i>p</i>-value < 0.001) and Stage 4B (aOR: 4.14, 95% CI: 4.04–4.24, <i>p</i>-value < 0.001). Notably, patients with CKM Stage 0 demonstrated higher odds of adverse outcomes compared to other stages. <b>Conclusions</b>: This study reveals a complex relationship between CKM syndrome severity and AMI outcomes. Patients with advanced CKM stages were more likely to undergo invasive procedures, and those without CKM risk factors unexpectedly showed worse outcomes. Among Stages 1–4B, no consistently graded association emerged between the CKM stage and adverse outcomes. These findings warrant further investigation into underlying mechanisms and long-term prognosis.
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spelling doaj-art-24bf56e934ea4d608365c0bbd8c532ae2025-08-20T02:28:28ZengMDPI AGDiseases2079-97212025-03-011349710.3390/diseases13040097Impact of Cardiovascular–Kidney–Metabolic Syndrome Staging on Myocardial Infarction Outcomes: A Retrospective Analysis of 2.7 Million PatientsRonny Shabtai0Marlon Villaga Gatuz1Adam Folman2Maguli S. Barel3Rami Abu-Fanne4Dmitry Abramov5Mamas A. Mamas6Ariel Roguin7Ofer Kobo8Adelson School of Medicine, Ariel University, Ariel 4070000, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Hadera 3820302, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Hadera 3820302, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Hadera 3820302, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Hadera 3820302, IsraelDepartment of Cardiology, Linda Loma University Health, Linda Loma, CA 92354, USAKeele Cardiovascular Research Group, Keele University, Newcastle ST5 5BG, UKDepartment of Cardiology, Hillel Yaffe Medical Center, Hadera 3820302, IsraelDepartment of Cardiology, Hillel Yaffe Medical Center, Hadera 3820302, Israel<b>Background</b>: Cardiovascular–kidney–metabolic (CKM) syndrome, recently defined by the American Heart Association, encompasses the interplay between obesity, diabetes, chronic kidney disease, and cardiovascular disease. This study aimed to investigate the impact of CKM syndrome severity on outcomes in patients with acute myocardial infarction (AMI). <b>Methods</b>: A retrospective analysis was conducted using the National Inpatient Sample database from 2016 to 2019. Adult patients hospitalized with AMI were stratified into CKM Stages 0–4 based on ICD-10 codes. Multivariable logistic regression models were used to examine associations between CKM stages and in-hospital procedures and outcomes. <b>Results</b>: The study analyzed 2,768,154 AMI cases. Advanced CKM stages were associated with older age and a higher proportion of males. Patients with severe CKM were more likely to undergo invasive procedures. Coronary angiography showed the strongest association in CKM Stage 4A (aOR: 6.86, 95% CI: 6.73–6.99, <i>p</i>-value < 0.001) and Stage 4B (aOR: 3.87, 95% CI: 3.80–3.95, <i>p</i>-value < 0.001). Similarly, the likelihood of PCI was highest in Stage 4A (aOR: 5.93, 95% CI: 5.79–6.08, <i>p</i>-value < 0.001) and Stage 4B (aOR: 4.14, 95% CI: 4.04–4.24, <i>p</i>-value < 0.001). Notably, patients with CKM Stage 0 demonstrated higher odds of adverse outcomes compared to other stages. <b>Conclusions</b>: This study reveals a complex relationship between CKM syndrome severity and AMI outcomes. Patients with advanced CKM stages were more likely to undergo invasive procedures, and those without CKM risk factors unexpectedly showed worse outcomes. Among Stages 1–4B, no consistently graded association emerged between the CKM stage and adverse outcomes. These findings warrant further investigation into underlying mechanisms and long-term prognosis.https://www.mdpi.com/2079-9721/13/4/97cardiovascular–kidney–metabolic syndromeacute myocardial infarctionrisk factorsoutcomes
spellingShingle Ronny Shabtai
Marlon Villaga Gatuz
Adam Folman
Maguli S. Barel
Rami Abu-Fanne
Dmitry Abramov
Mamas A. Mamas
Ariel Roguin
Ofer Kobo
Impact of Cardiovascular–Kidney–Metabolic Syndrome Staging on Myocardial Infarction Outcomes: A Retrospective Analysis of 2.7 Million Patients
Diseases
cardiovascular–kidney–metabolic syndrome
acute myocardial infarction
risk factors
outcomes
title Impact of Cardiovascular–Kidney–Metabolic Syndrome Staging on Myocardial Infarction Outcomes: A Retrospective Analysis of 2.7 Million Patients
title_full Impact of Cardiovascular–Kidney–Metabolic Syndrome Staging on Myocardial Infarction Outcomes: A Retrospective Analysis of 2.7 Million Patients
title_fullStr Impact of Cardiovascular–Kidney–Metabolic Syndrome Staging on Myocardial Infarction Outcomes: A Retrospective Analysis of 2.7 Million Patients
title_full_unstemmed Impact of Cardiovascular–Kidney–Metabolic Syndrome Staging on Myocardial Infarction Outcomes: A Retrospective Analysis of 2.7 Million Patients
title_short Impact of Cardiovascular–Kidney–Metabolic Syndrome Staging on Myocardial Infarction Outcomes: A Retrospective Analysis of 2.7 Million Patients
title_sort impact of cardiovascular kidney metabolic syndrome staging on myocardial infarction outcomes a retrospective analysis of 2 7 million patients
topic cardiovascular–kidney–metabolic syndrome
acute myocardial infarction
risk factors
outcomes
url https://www.mdpi.com/2079-9721/13/4/97
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