Abstract
BackgroundDiabetes mellitus (DM) and impaired glucose tolerance (IGT) are risk factors for acute myocardial infarction (AMI). However, it is unknown whether hyperglycemic state is associated with increased major adverse cardiovascular events (MACE) after AMI. In this study, we evaluated the relationship between glucometabolic status and MACE in patients after AMI, and determined the critical level of 2 h post-load plasma glucose that may be used to predict MACE.MethodsAMI patients (n = 422) were divided into 4 groups as follows: normal glucose tolerance (NGT) group, IGT group, newly diagnosed DM (NDM) group, and previously known DM (PDM) group. MACE of the 4 groups were compared for 2 years from AMI onset.ResultsThe NDM group had a significantly higher event rate than the IGT and NGT groups and had a similar event rate curve to PDM group. The logistic models analyses revealed that 2 h post-load plasma glucose values of ≥160 mg/dL was the only independent predictor of long-term MACE after AMI (p = 0.028, OR: 1.85, 95% CI: 1.07-3.21). The 2-year cardiac event rate of patients with a 2 h post-load hyperglycemia of ≥160 mg/dL was significantly higher than that of patients with 2 h post-load glucose of <160 mg/dL (32.2% vs. 19.8%, p < 0.05) and was similar to that of PDM group (37.4%, p = 0.513).ConclusionsNDM increases the risk of MACE after AMI as does PDM. Particularly, post-AMI patients with a 2 h post-load hyperglycemia ≥160 mg/dL may need adjunctive therapy after AMI.
Highlights
It is well known that diabetes mellitus (DM) is an independent risk factor for cardiovascular disease (CVD)
Classification of abnormal glucose tolerance Glucose abnormalities of study patients were classified into 4 groups using a 75 g oral glucose tolerance test (OGTT) according to the criteria for glucometabolic disturbances established by the World Health Organization (WHO)
Of the total 763 patients, we excluded a total of 247 patients; 48 patients for etiology of acute myocardial infarction (AMI), 11 patients for clinical history of type1 Diabetes mellitus (DM) and familial hyperlipidemia, and 188 patients who did not consent to have the 75 g OGTT
Summary
It is well known that diabetes mellitus (DM) is an independent risk factor for cardiovascular disease (CVD). Several previous studies have shown that postload hyperglycemia such as impaired glucose tolerance (IGT) is a risk factor for CVD [5,6,7]. The risk for poor long-term prognosis after AMI may be already apparent if patients have post-load hyperglycemia even at plasma glucose level well below the diabetic threshold. Diabetes mellitus (DM) and impaired glucose tolerance (IGT) are risk factors for acute myocardial infarction (AMI). It is unknown whether hyperglycemic state is associated with increased major adverse cardiovascular events (MACE) after AMI. We evaluated the relationship between glucometabolic status and MACE in patients after AMI, and determined the critical level of 2 h post-load plasma glucose that may be used to predict MACE
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