Abstract 3486: Insulin Resistance Adds Prognostic Information on Long-term Clinical Outcome After Acute Myocardial Infarction Among Japanese Patients with and without Glucose Intolerance
Background: Recent studies have demonstrated that newly diagnosed abnormal glucose tolerance (AGT) is common among the patients with acute myocardial infarction (AMI), and is a risk factor for future cardiovascular events. In the Caucasian population, insulin resistance (IR) mainly accounts for AGT. However, significance of this IR on long-term clinical outcome in Asian remains unclear. The purpose of this study was to determine whether the IR added prognostic information on long-term clinical outcome in Japanese patients with AMI.
Methods: We performed a prospective study, in which 220 consecutive patients who admitted due to AMI and had not been diagnosed as diabetes were enrolled. IR was defined as the homeostasis model assessment of IR (HOMA-IR, a surrogate for insulin resistance) ≥2.5. Those patients were divided into 4 groups based on this cutoff value of HOMA-IR and the 75g oral glucose tolerance test at discharge; 69 patients with normal glucose tolerance (NGT)/no IR, 12 patients with NGT/yes, 101 patients with AGT/no, and 38 patients with AGT/yes. We evaluated the association between the glucometabolic status and the long-term cardiovascular event rates.
Results: Median follow-up period was 4.5 years. The Kaplan-Meier survival curves showed IR provided additional prognostic information both for groups with NGT and AGT. The age-adjusted relative risks for future cardiovascular events in NGT/no, NGT/yes, AGT/no, and AGT/yes groups were 1.0 (referent), 2.65 (95%CI 0.81–8.63), 2.19 (1.02–4.71), and 4.4 (1.87–10.22), respectively.
Conclusions: IR adds prognostic information on long-term clinical cardiovascular outcome in Japanese patients with AMI.