Abstract
BackgroundAbnormal glucose metabolism including diabetes (DM) and prediabetes (pre-DM) have been reported as predictors of poorer outcomes after acute myocardial infarction (AMI). However, the prognostic value of pre-DM in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) remains unclear.MethodsA total of 1179 MINOCA patients were prospectively recruited and divided into normoglycemia (NG), pre-DM, and DM groups according to glycated hemoglobin (HbA1c) levels or past history. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization and hospitalization for unstable angina or heart failure. Kaplan–Meier and Cox regression analyses were performed.ResultsPatients with pre-DM and DM had a significantly higher incidence of MACE compared with NG group (10.8%, 16.1%, 19.4%; p = 0.003) over the median follow-up of 41.7 months. After multivariate adjustment, both pre-DM and DM were significantly associated with an increased risk of MACE (NG as reference; pre-DM: 1.45, 95% CI 1.03–2.09, p = 0.042; DM: HR 1.79, 95% CI 1.20–2.66, p = 0.005). At subgroup analysis, pre-DM remained a robust risk factor of MACE compared to NG. In addition, pre-DM had a similar impact as DM on long-term prognosis in patients with MINOCA.ConclusionsPre-DM defined as raised HbA1c was associated with a poor prognosis in patients with MINOCA. Routine assessment of HbA1c enables an early recognition of pre-DM and thus may facilitate risk stratification in this specific population.
Highlights
Patients with abnormal glucose metabolism have much worse outcomes than patients without after acute myocardial infarction (AMI), even in the setting of optimal medical therapy and revascularization with percutaneous coronary intervention (PCI) [1]
Since 2013, the measurement of H bA1c has been highly recommended by American Diabetes Association (ADA) to stratify glucose metabolism as follows: normoglycemia (NG, Glycated hemoglobin (HbA1c) < 5.7%), prediabetes, and diabetes (DM, H bA1c ≥ 6.5% or diagnosed DM) [3]
Baseline characteristics Patients were divided into NG, pre-DM and DM groups based on the HbA1c-defined glucometabolic status (NG, n = 572; pre-DM, n = 371; DM, n = 236) (Fig. 1)
Summary
Patients with abnormal glucose metabolism have much worse outcomes than patients without after acute myocardial infarction (AMI), even in the setting of optimal medical therapy and revascularization with percutaneous coronary intervention (PCI) [1]. A distinct group of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) has drawn an increasing awareness with the widespread use of coronary angiography in the management of AMI. It is reported that MINOCA accounts for 5–10% of all AMIs and disproportionately affects women and younger patients compared to those with AMI and obstructive coronary artery disease (CAD) [6,7,8]. Abnormal glucose metabolism including diabetes (DM) and prediabetes (pre-DM) have been reported as predictors of poorer outcomes after acute myocardial infarction (AMI). The prognostic value of pre-DM in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) remains unclear
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