The prognostic value of different glucose abnormalities in patients with acute myocardial infarction treated invasively

Abstract

BackgroundDiabetes (DM) deteriorates the prognosis in patients with coronary heart disease. However, the prognostic value of different glucose abnormalities (GA) other than DM in subjects with acute myocardial infarction (AMI) treated invasively remains unclear.AimsTo assess the incidence and impact of GA on clinical outcomes in AMI patients treated with percutaneous coronary intervention (PCI).MethodsA single-center, prospective registry encompassed 2733 consecutive AMI subjects treated with PCI. In all in-hospital survivors (n = 2527, 92.5%) without the history of DM diagnosed before or during index hospitalization standard oral glucose tolerance test (OGTT) was performed during stable condition before hospital discharge and interpreted according to WHO criteria. The mean follow-up period was 37.5 months.ResultsThe incidence of GA was as follows: impaired fasting glycaemia - IFG (n = 376, 15%); impaired glucose tolerance - IGT (n = 560, 22%); DM (n = 425, 17%); new onset DM (n = 384, 15%); and normal glucose tolerance – NGT (n = 782, 31%). During the long-term follow-up, death rate events for previously known DM, new onset DM and IGT were significantly more frequent than those for IFG and NGT (12.3; 9.6 and 9.4 vs. 5.6 and 6.4%, respectively, P < 0.05). The strongest and common independent predictors of death in GA patients were glomerular filtration rate < 60 ml/min/1,73 m^2 (HR 2.0 and 2.8) and left ventricle ejection fraction < 35% (HR 2.5 and 1.8, all P < 0.05) respectively.ConclusionsGlucose abnormalities are very common in AMI patients. DM, new onset DM and IGT increase remote mortality. Impaired glucose tolerance bears similar long-term prognosis as diabetes.

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

“…The authors emphasized that the main finding of their study was that IGT negatively affected the treatment outcomes and that the long-term prognosis of patients with IGT was similar to those with DM. The analysis of particular MACE which occurred during long-term observation showed that there were no significant differences between patients with normal glucose tolerance and IFG, IGT, or DM with respect to recurrent AMI, percutaneous coronary intervention, coronary artery by-pass grafting or stroke [17]. The adverse role of IGT in AMI patients was also confirmed in a study by George et al in which 42% of the study population was treated invasively [18].…”

“…Impaired fasting glycemia (isolated or coexisting with impaired glucose tolerance) was observed in 10-15%, but it was reported infrequently. In patients with coronary artery disease, 2h-PG has a similar diagnostic and prognostic usefulness as in other populations [12,13,14,15,16,17,18]. Tamita et al classified AMI patients with respect to fasting glucose as subjects with normal or impaired fasting glycemia and showed that there were no significant differences in the major adverse cardiovascular events (MACE) between those groups.…”

“…Nevertheless, early performance of OGTT, the exclusion of high-risk patients with heart failure and renal failure, which were shown to be independent risk factors of death in patients with glucose abnormalities [17], could have had a major impact on the obtained results. In published studies, the clinical characteristics of patients with AMI and newly detected abnormal glucose tolerance are not equivocal, however, those patients are generally more likely to be older, female, hypertensive, overweight or obese, they have a worse left ventricle ejection fraction and renal function, higher glycemia measured on hospital admission, higher fasting glucose levels, higher glycosylated hemoglobin and insulin, proinsulin, and triglycerides than patients with normoglycemia [12, 13,14,15,16,17,18,19,20,21]. In the majority of studies there were no differences in cardiovascular medical history with respect to different glucose abnormalities, except a study by Bartnik et al which showed that patients with abnormal glucose tolerance had a trend towards more heart failure history [21].…”

Adaptive Phenomenon of Ischemic Postconditioning of the Heart. Perspectives of Clinical Use

“…Сахарный диабет, по данным ряда авторов [24][25][26], встречается у 17-34% больных с острым коронарным синдромом. Принято считать, что данное заболевание существен-но усугубляет течение ОИМ [27].…”

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].…”