Abstract 3482: Improving Risk Stratification in Patients with Acute Myocardial Infarction Using a Simple Oral Glucose Tolerance Test
Introduction: Abnormal glucose regulation such as diabetes (DM) or impaired glucose tolerance (IGT) is common in patients with ischemic heart disease, and may adversely affect prognosis after acute MI. An increased amount of patients with abnormal glucose regulation are identified if an oral glucose tolerance test (OGTT) is performed in addition to measuring fasting blood glucose levels, but whether risk stratification is hereby improved remains uncertain.
Methods: A total of 403 consecutive patients admitted to the coronary care unit at Svendborg Hospital with acute MI were included in the study. In patients without a previously established diagnosis of DM, a standardized OGTT was performed before discharge. Capillary blood glucose levels were measured after an overnight fast and 2 hours after an orally administered 75g glucose load.
Results: Using WHO and American Diabetes Association criteria for DM and IGT, patients were categorized as having normal glucose regulation (34.0%), IGT (26.6%), new DM (22.6%) or known DM (16.9%). During 686 patient-years (mean 1.7 years) of follow-up, 59 (14.6%) patients died. Mortality-rates significantly rose with the degree of dysglycemia (figure⇓). After adjustment for age, gender, weight and previous MI, as well as exclusion of patients with previously diagnosed DM and patients in which a diagnosis of DM could have been made using the fasting sample alone, this association remained statistically significant (P=0.04).
Conclusion: Abnormal glucose regulation independently predicts mortality in patients with acute MI, and oral glucose tolerance testing of presumed non-diabetic patients significantly improves risk stratification.