Adjustment of the GRACE score by 2-hour post-load glucose improves prediction of long-term major adverse cardiac events in acute coronary syndrome in patients without known diabetes

Chattopadhyay, Sudipta; George, Anish; John, Joseph; Sathyapalan, Thozhukat

doi:10.1093/eurheartj/ehy233

Cited by 42 publications

(34 citation statements)

References 46 publications

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“…3,14 We have reported that 2h-PG was a better determinant of post-MI prognosis than FPG or APG. 13,21 In the EUORASPIRE IV 20 and Silent Diabetes Study, 27 2h-PG, but not FPG or HbA1c, was related to prognosis. The 2h-PG, but not the FPG, was associated with adverse post-MI prognosis in patients with pDM in this.…”

Section: Discussionmentioning

confidence: 98%

Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes

Chattopadhyay

George

John

et al. 2019

Diabetes and Vascular Disease Research

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Background: Effect of pre-diabetes mellitus on post-myocardial infarction prognosis is unclear. Methods: Retrospective cohort analysis of 1056 myocardial infarction survivors with fasting plasma glucose and 2-h post-load plasma glucose measured. Major adverse cardiovascular events included death, non-fatal reinfarction and ischaemic stroke. Cox proportional hazard regression identified predictors of event-free survival. Continuous net reclassification improvement and integrated discrimination improvement determined the added predictive value of glycaemic indices. Results: Major adverse cardiovascular events occurred in 25.1% and 16.4% patients with and without pre-diabetes mellitus (hazard ratio with pre-diabetes mellitus: 1.56; 95% confidence interval: 1.17–2.08; p = 0.003) in the whole cohort and in 24.1% and 17.2% patients (hazard ratio with pre-diabetes mellitus, 1.43; 95% confidence interval: 1.03–1.98; p = 0.033) in the matched cohort, respectively. Pre-diabetes mellitus predicted major adverse cardiovascular events–free survival in whole (hazard ratio: 1.39; 95% confidence interval: 1.03–1.89; p = 0.033) and matched cohorts (hazard ratio: 1.42; 95% confidence interval: 1.01–1.99; p = 0.043). The 2-h post-load plasma glucose, but not fasting plasma glucose, predicted major adverse cardiovascular events–free survival in the whole (hazard ratio: 1.16; 95% confidence interval: 1.07–1.26; p < 0.0001) and matched cohorts (hazard ratio: 1.20; 95% confidence interval: 1.09–1.31; p < 0.0001). Adding 2-h post-load plasma glucose to models containing fasting plasma glucose, significantly improved net reclassification improvement and integrated discrimination improvement for both cohorts, but not vice versa. Conclusion: Pre-diabetes mellitus predicts major adverse cardiovascular events after myocardial infarction. The 2-h post-load plasma glucose predicts prognosis better than fasting plasma glucose in these patients.

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Section: Discussionmentioning

confidence: 98%

Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes

Chattopadhyay

George

John

et al. 2019

Diabetes and Vascular Disease Research

Self Cite

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“…The 2hPG also improved the predictability of the Global Registry of Acute Coronary Events (GRACE) risk score. 169 Unfortunately, HbA1c was not included in this study. In the present study, 2hPG indicating IGT (n=1,242) was significantly associated with the primary endpoint, while the 2hPG indicating T2DM (n=435) showed a similar trend with borderline statistical significance, probably due to the lack of power, given the results of previous studies.…”

Section: Prognostic Implications Of Indicators Of Dysglycaemiamentioning

confidence: 99%

The Accuracy of Point-of-Care Equipment for Glucose Measurement in Screening for Dysglycemia in Patients with Coronary Artery Disease

Shahim

Kjellström

Gyberg

et al. 2018

Diabetes Technology & Therapeutics

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“…Among common cardiovascular risk factors, type 2 diabetes and its preceding state, impaired glucose tolerance (IGT), designated together as dysglycemia, increase the risk for CVD by two to four times (2). Moreover, future morbidity and mortality of patients with coronary artery disease (CAD) is considerably higher in the presence of dysglycemia, including newly detected glucose perturbations (3)(4)(5). Nonetheless, type 2 diabetes and IGT remain unrecognized in approximately two-thirds of coronary patients (6,7).…”

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confidence: 99%

Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Disease—A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V

et al. 2020

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Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects. RESEARCH DESIGN AND METHODS The European Society of Cardiology's European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016-2017) included 8,261 CAD patients, aged 18-80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A 1c. Lifestyle, risk factors, and pharmacological management were investigated. RESULTS A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that selfreported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium-glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small. CONCLUSIONS Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.

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Adjustment of the GRACE score by 2-hour post-load glucose improves prediction of long-term major adverse cardiac events in acute coronary syndrome in patients without known diabetes

Abstract: Two-hour PG, but not FPG, is an independent predictor of adverse outcome after ACE even after adjusting for the GRS. Two-hour PG, but not FPG, improves the predictability of prognostic models containing GRS.

Cited by 42 publications

References 46 publications

Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes

Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes

The Accuracy of Point-of-Care Equipment for Glucose Measurement in Screening for Dysglycemia in Patients with Coronary Artery Disease

Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Disease—A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V

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