Increased risk of endotracheal intubation and heart failure following acute myocardial infarction in patients with urolithiasis: a nationwide population-based study

Abstract

Background

Urolithiasis is a common urinary tract disease worldwide. It has been connected to systemic diseases, including hypertension, diabetes mellitus, metabolic syndrome, and cardiovascular disease. In the current study, we aimed to evaluate the relationship between urolithiasis and the complications of acute myocardial infarction (AMI).

Materials and methods

Data were obtained from the Longitudinal Health Insurance Database 2005 of the National Health Insurance Research Database. All AMI cases, both those who were hospitalized and those who were treated in the emergency department, were identified using the International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) code.

Results

A total of 37,052 patients with urinary calculi and 148,209 control subjects were enrolled in this study. The average follow-up period was 9.51 years. The risk of AMI was higher among patients with urolithiasis (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [95% CI] 1.03–1.13). We detected a significant association between urolithiasis and intubation (aHR 1.53, 95% CI 1.36–1.73), intensive care unit treatment (aHR 1.22, 95% CI 1.13–1.32), heart failure (aHR 1.59, 95% CI 1.42–1.78), shock (aHR 1.53, 95% CI 1.32–1.77), and arrhythmias (aHR 1.18, 95% CI 1.06–1.33). Furthermore, certain medical treatments for urolithiasis were found to be related to myocardial infarction (MI). Nonsteroidal anti-inflammatory drugs (NSAIDs) were significantly associated with a high risk of AMI. In contrast, allopurinol, thiazide diuretic, potassium-sparing diuretics, and α-blockers have negative association with AMI.

Conclusion

Urolithiasis had a significantly increased risk of endotracheal intubation and heart failure following AMI. In addition, urolithiasis was also associated with a high risk of intensive care unit treatment, shock, and arrhythmias after AMI. Medical treatments for urolithiasis may decrease the risk of MI, except the use of NSAIDs.

Keywords:

• urolithiasis
• renal calculi
• acute myocardial infarction
• National Health Insurance Research Database
• endotracheal intubation
• heart failure

Supplementary materials

Table S1 MI risk adjusted for medication use

Table S2 Time from surgical management for urinary tract stones to MI

Acknowledgments

We would like to express our appreciation for the support provided by the National Health Insurance Administration; the Ministry of Health and Welfare, Executive Yuan, Taiwan; and the Taipei City Hospital. The work was supported by grants from the Ministry of Health and Welfare (10510).

Author contributions

S-KL wrote the manuscript and performed data analysis. J-ML wrote the proposal and designed the manuscript. R-JH and Y-TT contributed to the conception of the study. P-HL revised the manuscript. All the authors contributed toward data analysis, drafting and critically revising the article, read and approved the final manuscript, and agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.