Ahmed, S., Cannon, C. P., Giugliano, R. P., Murphy, S. A., Morrow, D. A., Antman, E. M., Braunwald, E., Gibson, C. M. The independent and combined risk of diabetes and non-endstage renal impairment in non-ST-segment elevation acute coronary syndromes Int J Cardiol. 2008;131(1):105-12.

OBJECTIVES: To assess the effect of renal impairment (RI) and diabetes (DM) on outcomes in non-ST-segment elevation acute coronary syndromes (NSTE-ACS).

METHODS: Data were pooled from 13,126 patients in five NSTE-ACS TIMI trials (TIMI 11A and B, TIMI 12, OPUS-TIMI 16, and TACTICS-TIMI 18). Patients were divided based on DM status and RI (none, mild, or moderate if the glomerular filtration rate (GFR, ml/min/1.73 m(2)) was > or = 90, 60-89 and 30-59 respectively). RESULTS: Patients with DM and moderate RI (n=609) were older and had more prior MI (p<0.01 for all) than other subgroups. Compared with no RI/DM (n=3,832), the 12-month adjusted risks of death, MI, and death/MI increased with advancing RI and were highest with DM and moderate RI (H.R. 1.7, (1.2-2.4), p=0.002; H.R. 2.0 (1.5-2.6), p<0.001; and H.R. 1.7 (1.3-2.2), p<0.001 respectively). These events were also increased with DM and mild RI (H.R. 1.4, (1.0-1.9), p=0.06, H.R. 1.4 (1.1-1.8), p=0.006 and H.R. 1.3 (1.1-1.7), p=0.007 respectively) but not with 1) mild or moderate RI without DM or 2) DM without RI. The interaction terms for RI and DM in their association with MI and death/MI were significant.

CONCLUSIONS: In the absence of DM, RI and in the absence of RI, DM did not increase the risk of MI or death/MI. However, the combination of RI and DM was associated with a particularly high risk of MI and death/MI suggesting that attention to preserving renal function may be of particular benefit for reducing cardiovascular risk in diabetic patients.