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

Abstract

Background: Diabetes (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.

Aims: To assess the incidence and impact of GA on clinical outcomes in AMI patients treated with percutaneous coronary intervention (PCI).

Methods: A 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.

Results: The 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.

Conclusions: Glucose 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.

Figure 1

Study population selection, AMI – acute myocardial infarction, OGTT – oral glucose tolerance test, DM new onset – newly diagnosed diabetes mellitus, DM – diabetes mellitus diagnosed previously, IGT – impaired glucose tolerance, IFG – impaired fasting glucose, NGT – normal glucose tolerance.

Figure 2

Kaplan-Meier survival curves in particular study groups, NGT – normal glucose tolerance, New DM – newly diagnosed diabetes mellitus, DM – diabetes mellitus diagnosed previously, IGT – impaired glucose tolerance, IFG – impaired fasting glucose, IFG and control group vs IGT, new onset DM and DM; p < 0.05. IFG vs control group; p = NS. IGT vs new onset DM vs DM; p = NS. Time in months.