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

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          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.


          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.


          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.

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          Most cited references 26

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          Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction.

          The presence of coexisting conditions has a substantial effect on the outcome of acute myocardial infarction. Renal failure is associated with one of the highest risks, but the influence of milder degrees of renal impairment is less well defined. As part of the Valsartan in Acute Myocardial Infarction Trial (VALIANT), we identified 14,527 patients with acute myocardial infarction complicated by clinical or radiologic signs of heart failure, left ventricular dysfunction, or both, and a documented serum creatinine measurement. Patients were randomly assigned to receive captopril, valsartan, or both. The glomerular filtration rate (GFR) was estimated by means of the four-component Modification of Diet in Renal Disease equation, and the patients were grouped according to their estimated GFR. We used a 70-candidate variable model to adjust and compare overall mortality and composite cardiovascular events among four GFR groups. The distribution of estimated GFR was wide and normally shaped, with a mean (+/-SD) value of 70+/-21 ml per minute per 1.73 m2 of body-surface area. The prevalence of coexisting risk factors, prior cardiovascular disease, and a Killip class of more than I was greatest among patients with a reduced estimated GFR (less than 45.0 ml per minute per 1.73 m2), and the use of aspirin, beta-blockers, statins, or coronary-revascularization procedures was lowest in this group. The risk of death or the composite end point of death from cardiovascular causes, reinfarction, congestive heart failure, stroke, or resuscitation after cardiac arrest increased with declining estimated GFRs. Although the rate of renal events increased with declining estimated GFRs, the adverse outcomes were predominantly cardiovascular. Below 81.0 ml per minute per 1.73 m2, each reduction of the estimated GFR by 10 units was associated with a hazard ratio for death and nonfatal cardiovascular outcomes of 1.10 (95 percent confidence interval, 1.08 to 1.12), which was independent of the treatment assignment. Even mild renal disease, as assessed by the estimated GFR, should be considered a major risk factor for cardiovascular complications after a myocardial infarction. Copyright 2004 Massachusetts Medical Society
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            Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study.

            Controversy has surrounded the question about whether high-dose rofecoxib increases or naproxen decreases the risk of serious coronary heart disease. We sought to establish if risk was enhanced with rofecoxib at either high or standard doses compared with remote non-steroidal anti-inflammatory drug (NSAID) use or celecoxib use, because celecoxib was the most common alternative to rofecoxib. We used data from Kaiser Permanente in California to assemble a cohort of all patients age 18-84 years treated with a NSAID between Jan 1, 1999, and Dec 31, 2001, within which we did a nested case-control study. Cases of serious coronary heart disease (acute myocardial infarction and sudden cardiac death) were risk-set matched with four controls for age, sex, and health plan region. Current exposure to cyclo-oxygenase 2 selective and non-selective NSAIDs was compared with remote exposure to any NSAID, and rofecoxib was compared with celecoxib. During 2302029 person-years of follow-up, 8143 cases of serious coronary heart disease occurred, of which 2210 (27.1%) were fatal. Multivariate adjusted odds ratios versus celecoxib were: for rofecoxib (all doses), 1.59 (95% CI 1.10-2.32, p=0.015); for rofecoxib 25 mg/day or less, 1.47 (0.99-2.17, p=0.054); and for rofecoxib greater than 25 mg/day, 3.58 (1.27-10.11, p=0.016). For naproxen versus remote NSAID use the adjusted odds ratio was 1.14 (1.00-1.30, p=0.05). Rofecoxib use increases the risk of serious coronary heart disease compared with celecoxib use. Naproxen use does not protect against serious coronary heart disease.
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              Diabetes mellitus and the risk of nephrolithiasis.

              Insulin resistance is a central feature of type 2 diabetes mellitus (DM) and may increase the risk of kidney stone formation. Existing cross-sectional data on the association between DM and nephrolithiasis are limited, and no prospective study to date has evaluated the relation between DM and the risk of kidney stones. To evaluate the relation between DM and prevalent kidney stones, we conducted a cross-sectional study of 3 large cohorts including over 200,000 participants: the Nurses' Health Study I (older women), the Nurses' Health Study II (younger women), and the Health Professionals Follow-up Study (men). We then prospectively studied the association between DM and incident nephrolithiasis over a combined 44 years of follow-up. Because insulin resistance can precede the diagnosis of DM by decades, we also prospectively examined the relation between kidney stones and the diagnosis of incident DM. Multivariate regression models adjusted for age, body mass index, thiazide diuretic use, fluid intake, and dietary factors. At baseline, the multivariate relative risk of prevalent stone disease in individuals with DM compared to individuals without was 1.38 (95% CI 1.06-1.79) in older women, 1.67 (95% CI 1.28-2.20) in younger women, and 1.31 (95% CI 1.11-1.54) in men. Prospectively, the multivariate relative risk of incident kidney stone formation in participants with DM compared to participants without was 1.29 (95% CI 1.05-1.58) in older women, 1.60 (95% CI 1.16-2.21) in younger women, and 0.81 (95% CI 0.59-1.09) in men. The multivariate relative risk of incident DM in participants with a history of kidney stones compared to participants without was 1.33 (95% CI 1.18-1.50) in older women, 1.48 (95% CI 1.14-1.91) in younger women, and 1.49 (95% CI 1.29-1.72) in men. DM is a risk factor for the development of kidney stones. Additional studies are needed to determine if the increased risk of DM in stone formers is due to subclinical insulin resistance.

                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                23 February 2017
                : 13
                : 245-253
                [1 ]Institute of Traditional Medicine, School of Medicine, National Yang-Ming University
                [2 ]Department of Chinese Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei
                [3 ]Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare
                [4 ]Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan
                [5 ]Division of Urology, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua
                [6 ]Biobank Management Center of the Tri-Service General Hospital
                [7 ]Department of Pathology and Graduate Institute of Pathology and Parasitology, the Tri-Service General Hospital
                [8 ]Graduate Institute of Life Sciences, National Defense Medical Center, Taipei
                [9 ]Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
                Author notes
                Correspondence: Po-Hung Lin, Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, No 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan, Republic of China, Tel +886 3 328 1200 2103, Email m7587@ 123456adm.cgmh.org.tw

                These authors contributed equally to this work

                © 2017 Lin et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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