Prognostic significance of HbA1c in patients with AMI treated invasively and newly detected glucose abnormalities

Kowalczyk, Jacek; Mazurek, Michał; Zielińska, Teresa; Lenarczyk, Radosław; Sedkowska, Agnieszka; Świątkowski, Andrzej Marian; Średniawa, Beata; Mencel, Grzegorz; Francuz, Paweł; Kalarus, Zbigniew

doi:10.1177/2047487314527850

Cited by 26 publications

(31 citation statements)

References 25 publications

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“…[10,24,26,27] Pool analysis of these 4 study confirmed the conclusion that the elevated HbA1c level was associated with higher long-term mortality (OR 2.46, 95%CI 2.19–2.73, P < .001). A significant heterogeneity was noted ( I 2 = 98.2%, P < .001).…”

Section: Resultssupporting

confidence: 62%

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Glycosylated hemoglobin levels and clinical outcomes in nondiabetic patients with coronary artery disease

et al. 2017

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Section: Resultssupporting

confidence: 62%

“…Specially, study heterogeneity was much less when the study by Kowalczyk was omitted ( I 2 = 17.7%, P = .251), and the pooled estimate of OR was 1.56 (95%CI 1.36–1.80, P < .001). [24] …”

Section: Resultsmentioning

confidence: 99%

Glycosylated hemoglobin levels and clinical outcomes in nondiabetic patients with coronary artery disease

et al. 2017

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“…Initial data had indicated that the prognosis in patients with AGT was significantly determined in the early post-infarction period, but more recent studies have shown that AGT is also associated with worse long-term outcome [1][2][3][4]. In the presented work, among patients without pre-hospital DM, who completed FU-visit, risk stratification with respect to glucometabolic status when performed at hospital discharge revealed no significant differences in remote mortality between AGT and NGT.…”

Section: Discussionmentioning

confidence: 58%

“…Glucometabolic status evaluated by two-hour post-load glycaemia (2h-PG) during oral glucose tolerance test (OGTT) has been a well-established risk factor for worse prognosis in patients with acute myocardial infarction (AMI) [1][2][3][4]. Newly detected diabetes mellitus (DM) or impaired glucose tolerance were associated with similar mortality to pre-hospital diabetes [5].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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A b s t r a c tBackground: Glucometabolic status (GS) in patients with acute myocardial infarction (AMI) has an impact on prognosis, but it may change over time. Aim:To evaluate the prognosis after AMI treated invasively with respect to changes in GS assessed by oral glucose tolerance test at discharge and at mid-term follow-up visit (FU-visit).Methods: Glucometabolic status was assessed by two-hour post-load glycaemia and defined as abnormal glucose tolerance (AGT) or normal glucose tolerance (NGT). Out of 454 in-hospital AMI survivors, 368 (81%) patients completed an FU-visit and were divided into four groups with respect to GS at discharge and FU-visit: group 1 -AGT at discharge and FU-visit (n = 101); group 2 -AGT at discharge and NGT at FU-visit (n = 48); group 3 -NGT at discharge and AGT at FU-visit (n = 114); and group 4 -NGT at discharge and FU-visit (n = 105). All-cause mortality was compared between groups with log-rank test.Results: Median time from AMI to FU-visit was seven months. Median remote follow-up duration after AMI was 31 months. Two-hour post load glycaemia was significantly higher in patients with confirmed AGT at FU-visit than in other groups. Mortality was higher in group 1 (11.9%) than in group 2 (2.1%; p = 0.034) and group 4 (2.9%; p = 0.009). Mortality rates between group 2 and 4 were similar (2.1% vs. 2.9%; p = 0.781). There was no significant difference in mortality between group 1 and group 3 (11.9% vs. 6.1%; p = 0.114). Mortality in group 3 was over two-fold higher than in group 4; however, this difference was statistically non-significant (6.1% vs. 2.9%; p = 0.247). Conclusions:Prognosis for patients with confirmed AGT was unfavourable; however, patients with AGT at discharge, in whom GS improved, had similar mortality to subjects with persistent NGT. The major clinical implication from this study is the finding that reassessment of GS by repeated oral glucose tolerance test has significant prognostic value and makes initial risk stratification performed at discharge more reliable.

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“…It should be noted that in patients with abnormal 2h-PG and normal fasting glucose, the risk of death is underestimated [8]. Elevated 2h-PG was also found to be a risk factor of mortality, independent of the levels of glycosylated hemoglobin (HbA1c), although HBA1c was a prognostic factor in patients with acute myocardial infarction (AMI) and newly detected glucose abnormalities [9,10]. The most recent guidelines dedicated to the topic of diabetes, pre-diabetes and cardiovascular disease published by the European Society of Cardiology (ESC) recommend fasting glycemia and HbA1c as primary screening methods, but also advocated OGTT as the preferred one to detect glucose abnormalities in patients with acute coronary syndrome [11].…”

Section: Introductionmentioning

confidence: 99%

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

Francuz

Podolecki

Szymała

et al. 2017

Ann. Acad. Med. Siles.

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AB ST R ACTTwo-hour post load glycemia (2h-PG) obtained during the oral glucose tolerance test (OGTT) is related to adverse cardiovascular outcomes more significantly than fasting glycemia, and the association of 2h-PG with cardiovascular morbidity is graded and independent. An abnormal value of 2h-PG is defined as glycemia ≥ 7.8 mmol/l (140 mg/dl) in most studies. Patients with acute myocardial infarction with abnormal 2h-PG compared to patients with normal 2h-PG have a significantly higher long-term mortality and more concomitant diseases, however, it has not been shown that those subjects have a higher risk of myocardial infarction, coronary revascularization or stroke. Studies have shown that in some patients the glucometabolic status changes after the acute phase of the disease, and that those changes have a prognostic importance. In this review article the authors presented the significance, epidemiology, natural course of glucometabolic disturbances and the therapeutic concerns of hypoglycemic treatment. K E Y W O R D Sacute myocardial infarction, oral glucose tolerance test, glucometabolic disturbances

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Prognostic significance of HbA1c in patients with AMI treated invasively and newly detected glucose abnormalities

Cited by 26 publications

References 25 publications

Glycosylated hemoglobin levels and clinical outcomes in nondiabetic patients with coronary artery disease

Glycosylated hemoglobin levels and clinical outcomes in nondiabetic patients with coronary artery disease

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

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

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