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

Abstract

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.

Long term prognostic implication of newly detected abnormal glucose tolerance among patients with stable cardiovascular disease: a population-based study

“…and 22% higher risk of CVD and CHD, respectively. Moreover, finding of some studies showed that IGT was associated with worse post MI prognosis [9,22] while some showed no significant risk [26] and study by George et al [23] revealed that IGT is associated with higher risk of MACE but not hard CVD outcomes. The findings of our study however, showed that the risk of CVD/CHD and the related hard outcomes does not increase among those with IGT; in line with other studies conducted among low risk population with prevalent CAD [8,34].…”

“…Firstly, most of them were performed among admitted patients with high baseline risk for recurrent event i.e., those with MI [10,11,[21][22][23][24][25] who had data on OGTT before discharging from hospital or those with history of PCI/CABG [9]. Secondly, there was a great difference between studies in terms of sample size, follow-up duration, approaching FPG and 2 h-PCPG as a continuous or categorical variable and heterogeneity in outcome definitions (CVD, MACE, all-cause or cardiovascular mortality).…”

“…Focusing on 2 h-PCPG, some studies suggest that 2 h-PCPG is a better determinant for assessing the prognosis of post ACS patients than FPG. Notably, some authors suggest that adding 2 h-PCPG (but not FPG) to the Global Registry of Acute Coronary Events (GRACE) score (an established risk model for recurrent cardiac events), can improve the prediction power of the model in post MI patients without known diabetes [22,27]. Furthermore, the finding of the study by Chattopadhyay showed that 2 h-PCPG as a continues variable is a better predictor of adverse post MI outcomes compared to FPG [28].…”

Clinical Characteristics of Patients Under Routine Sedation in Endovascular Treatment of Ischemic Heart Disease

“…Майже чверть пацієнтів (24,66 %) мали в анамнезі ІМ різної локалізації, а третина хворих мали порушення вуглеводного обміну, що проявлялися гіперглікемією. Цей факт підтверджує те, що цукровий діабет пов'язаний з виникненням ІХС [18,19,20] та погіршує прогноз при виникненні інфаркту міокарда [21,22].…”

Comment on Kiviniemi et al. Prediabetes and Risk for Cardiac Death Among Patients With Coronary Artery Disease: The ARTEMIS Study. Diabetes Care 2019;42:1319–1325

“…Prediabetes has been shown to independently predict post-ACS prognosis (2,3). In a study of exclusively ACS patients (2), prediabetes, adjusted for several covariates including the GRACE score, independently predicted prognosis.…”