Impact of newly diagnosed abnormal glucose regulation on long-term prognosis in low risk patients with ST-elevation myocardial infarction: A follow-up study

Abstract

BackgroundPatients with acute myocardial infarction and newly detected abnormal glucose regulation have been shown to have a less favourable prognosis compared to patients with normal glucose regulation. The importance and timing of oral glucose tolerance testing (OGTT) in patients with acute myocardial infarction without known diabetes is uncertain. The aim of the present study was to evaluate the impact of abnormal glucose regulation classified by an OGTT in-hospital and at three-month follow-up on clinical outcome in patients with acute ST elevation myocardial infarction (STEMI) without known diabetes.MethodsPatients (n = 224, age 58 years) with a primary percutanous coronary intervention (PCI) treated STEMI were followed for clinical events (all-cause mortality, non-fatal myocardial re-infarction, recurrent ischemia causing hospital admission, and stroke). The patients were classified by a standardised 75 g OGTT at two time points, first, at a median time of 16.5 hours after hospital admission, then at three-month follow-up. Based on the OGTT results, the patients were categorised according to the WHO criteria and the term abnormal glucose regulation was defined as the sum of impaired fasting glucose, impaired glucose tolerance and type 2-diabetes.ResultsThe number of patients diagnosed with abnormal glucose regulation in-hospital and at three-month was 105 (47%) and 50 (25%), respectively. During the follow up time of (median) 33 (27, 39) months, 58 (25.9%) patients experienced a new clinical event. There were six deaths, 15 non-fatal re-infarction, 33 recurrent ischemia, and four strokes. Kaplan-Meier analysis of survival free of composite end-points showed similar results in patients with abnormal and normal glucose regulation, both when classified in-hospital (p = 0.4) and re-classified three months later (p = 0.3).ConclusionsPatients with a primary PCI treated STEMI, without previously known diabetes, appear to have an excellent long-term prognosis, independent of the glucometabolic state classified by an OGTT in-hospital or at three-month follow-up.Trial registrationThe trial is registered at http://www.clinicaltrials.gov, NCT00926133.

Glucose abnormalities detected by oral glucose tolerance test in patients with acute myocardial infarction: clinical significance, epidemiology, natural course and therapeutic concerns

“…Although patients with abnormal glucose regulation were not started on glucose lowering medication, had a higher serum peak level of cardiac troponin, larger myocardial infarct size, and more severe glucometabolic derangement, their prognosis was similar to those with normoglycemia [19]. The authors of the cited study suggested that a low prevalence of DM (24% of abnormal glucose regulation group and 11% of total study population) could have been related to the obtained results [19]. Patients with IFG were also included in the abnormal glucose regulation group, which could have resulted in a more favorable outcome.…”

“…It was associated with older age, higher proportion of female gender, higher serum peak level of cardiac troponin, a larger myocardial infarct size measured as % of left ventricular mass three months later, significantly higher levels of glycosylated hemoglobin, insulin, proinsulin, C-peptide, and a higher homeostasis model assessment-estimated insulin resistance index (HOMA-IR) [19]. Although patients with abnormal glucose regulation were not started on glucose lowering medication, had a higher serum peak level of cardiac troponin, larger myocardial infarct size, and more severe glucometabolic derangement, their prognosis was similar to those with normoglycemia [19]. The authors of the cited study suggested that a low prevalence of DM (24% of abnormal glucose regulation group and 11% of total study population) could have been related to the obtained results [19].…”

“…To the authors' knowledge, there is only one study which showed that newly detected dysglycemia in AMI patients had no impact on the prognosis. Knudsen et al showed that in patients treated invasively due to ST elevation AMI, the oral glucose tolerance test performed within 24 hours after hospital admission revealed that newly detected abnormal glucose regulation was prevalent in 47% of study subjects [19]. It was associated with older age, higher proportion of female gender, higher serum peak level of cardiac troponin, a larger myocardial infarct size measured as % of left ventricular mass three months later, significantly higher levels of glycosylated hemoglobin, insulin, proinsulin, C-peptide, and a higher homeostasis model assessment-estimated insulin resistance index (HOMA-IR) [19].…”

“…Knudsen et al showed that in patients treated invasively due to ST elevation AMI, the oral glucose tolerance test performed within 24 hours after hospital admission revealed that newly detected abnormal glucose regulation was prevalent in 47% of study subjects [19]. It was associated with older age, higher proportion of female gender, higher serum peak level of cardiac troponin, a larger myocardial infarct size measured as % of left ventricular mass three months later, significantly higher levels of glycosylated hemoglobin, insulin, proinsulin, C-peptide, and a higher homeostasis model assessment-estimated insulin resistance index (HOMA-IR) [19]. Although patients with abnormal glucose regulation were not started on glucose lowering medication, had a higher serum peak level of cardiac troponin, larger myocardial infarct size, and more severe glucometabolic derangement, their prognosis was similar to those with normoglycemia [19].…”

Long-term prognosis is related to mid-term changes of glucometabolic status in patients with acute myocardial infarction treated invasively

“…Newly detected diabetes mellitus (DM) or impaired glucose tolerance were associated with similar mortality to pre-hospital diabetes [5]. In stable patients after AMI, derangements in glucose metabolism defined at hospital discharge were shown to be transient, persistent, unchanged, or newly detected [6][7][8][9][10]. However, there are no recommendations on repeated OGTT in patients after AMI.…”