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.
Highlights
Patients 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
We have previously reported that patients with a primary percutanous coronary intervention (PCI) treated ST elevation myocardial infarction (STEMI) without known diabetes, have a high prevalence of undetected abnormal glucose regulation classified by an oral glucose tolerance testing (OGTT) either in-hospital or three months later [10]
Our main result was that stable STEMI patients without previously known diabetes have an excellent long-term prognosis independently of newly detected abnormal glucose regulation made by an OGTT screening either in-hospital or at three-month follow-up
Summary
Patients 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. An increased risk of cardiovascular morbidity and mortality has been demonstrated in patients with acute MI and newly detected abnormal glucose regulation [8], emphasizing the importance of diagnosing these patients at an early stage. We have previously reported that patients with a primary PCI treated STEMI without known diabetes, have a high prevalence of undetected abnormal glucose regulation classified by an OGTT either in-hospital or three months later [10]. The OGTT performed early after a STEMI did not provide reliable information on longterm glucometabolic state [10]
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