Abstract 3484: Post-challenge Glucose Classification is a Better Risk Predictor for Future Cardiovascular Event After Acute Myocardial Infarction than Fasting Glucose Classification
Background: Recent studies have demonstrated that newly diagnosed abnormal glucose tolerance (AGT; DM and impaired glucose tolerance) determined by the presence of post-challenge hyperglycemia is common among the patients with acute myocardial infarction (AMI). However, the measurements of fasting plasma glucose dominate screening after AMI in current clinical settings. The purpose of this study was to assess long-term clinical outcome associated with the fasting glucose classification compared with the 2-h post-challenge glucose classification.
Methods: We performed prospective study, in which 275 consecutive patients admitted to our coronary care unit due to AMI were enrolled. Eighty five patients were pre-diagnosed DM, while the other 190 patients had not been diagnosed as DM. The patients without DM were divided into two groups based on the 75g oral glucose tolerance test at discharge; 78 patients with normal glucose tolerance (NGT) and 112 patients with AGT. The same patients were also reclassified into the normal fasting glucose (NFG; n=168) group or the impaired fasting glucose (IFG; n=22) group. We evaluated the association between the glucometabolic status and the long-term major adverse cardiovascular event (MACE) rates among these three groups.
Results: Median follow-up period was 5.3 years. The Cox’s proportional hazard model analysis showed that the hazard ratio of AGT to NGT on MACE was 2.65 (95% CI: 1.37–5.15, P=0.004), while the hazard ratio of pre-diagnosed DM to NGT was 3.27 (1.68–6.38; p=0.0005). However, the Cox’s hazard ratio of IFG to NFG on MACE was 1.83 (0.86–3.87), which was not significant.
Conclusions: In patients with AMI, post-challenge glucometabolic status is a better risk factor for future cardiovascular events than fasting glucose level and may critically distinguish high-risk individuals.