BACKGROUND: Chronic kidney disease (CKD) and metabolic dysfunction-associated steatotic liver disease (MASLD) have been associated with an increased risk of cardiovascular disease. OBJECTIVE: This study seeks to examine the prognostic value of the coexistence of CKD and MASLD in patients presenting with acute myocardial infarction (AMI). METHODS: This cohort study describes the clinical characteristics and long-term outcomes of patients following AMI, stratified by the presence of CKD and MASLD. A Kaplan-Meier curve was constructed for 30-day mortality. Cox regression analysis was used to investigate independent predictors of long-term all-cause mortality, adjusted for age, sex, ethnicity, previous AMI, AMI type, and left ventricular ejection fraction (LVEF). RESULTS: A total of 6757 patients with AMI were examined. Those with coexisting CKD and MASLD (CKD(+)/MASLD(+)) had the highest rates of obesity (97.7%, p < 0.001), type 2 diabetes mellitus (85.7%, p < 0.001), hypertension (92.7%, p < 0.001), dyslipidemia (84.1%, p < 0.001), and previous stroke (17.8%, p < 0.001). On discharge, this group was least likely to be prescribed angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) (p < 0.001) and statins (p < 0.001). Additionally, this group had the highest rates of cardiac arrest (5.9%, p = 0.014), cardiogenic shock (15.5%, p < 0.001), and 30-day all-cause mortality (17.8%, p < 0.001). Cox regression demonstrated that the CKD(+)/MASLD(+) (HR 2.412, 95% CI 1.946-2.990, p < 0.001) and CKD(+)/MASLD(-) (HR 2.108, 95% CI 1.789-2.482, p < 0.001) phenotypes were independent predictors of mortality. CONCLUSIONS: CKD (+)/MASLD(+) embodied a higher metabolic burden and was the strongest independent predictor of mortality in AMI, with higher rates of cardiac arrest and cardiogenic shock. Further studies of early intervention in this group could help to improve outcomes.
Zhang et al. (2026) studied this question.