Impact of Cardiovascular-Kidney-Metabolic Syndrome on Myocardial Infarction Outcomes

Background: Cardiovascular-kidney-metabolic (CKM) syndrome, defined by the American Heart Association in 2023, encompasses obesity, diabetes, chronic kidney disease, and cardiovascular disease (CVD) interactions, elevating CVD risk, a leading cause of mortality. However, its effect on myocardial infarction (MI) prognosis remains unclear. This study investigated the relationship between CKM syndrome stages and clinical outcomes in MI patients.

Methods: Using the National Inpatient Sample database (2016–2019), adult MI patients were stratified by CKM syndrome stages (0–4) based on severity. In-hospital outcomes, including major adverse cardiovascular and cerebrovascular events (MACCE), mortality, acute cerebrovascular accidents (CVA), major bleeding, and invasive procedures—percutaneous coronary interventions (PCI), coronary angiography, and coronary artery bypass grafting (CABG)—were assessed by CKM stage.

Results: Among 2,768,154 MI patients, advancing CKM stages correlated with older age and higher male prevalence. Patients with higher CKM stages demonstrated an increased likelihood of undergoing PCI, CABG, and coronary angiography. However, mortality risk decreased with higher CKM stages (e.g., OR CKM-4A 0.28, 95% CI 0.272–0.287, p < 0.001; CKM-4B 0.386, 95% CI 0.375–0.389, p < 0.001), as did major bleeding events (e.g., OR CKM-4A 0.726, 95% CI 0.697–0.756, p < 0.001; CKM-4B 0.65, 95% CI 0.623–0.678, p < 0.001).

Conclusions: This study highlights the complex interplay between CKM syndrome and MI. Advanced CKM stages are associated with increased use of invasive procedures and paradoxically improved in-hospital outcomes, including reduced mortality and bleeding risks. These findings underscore the importance of personalized risk stratification and the need for further research to elucidate CKM syndrome`s impact on MI prognosis