Abstract 4050: Increased Short-Term Morbidity and Mortality After Acute Myocardial Infarction (MI) in Patients with Impaired Fasting Glycemia (IFG) Between 110 and 126 mg/dl, but not IFG Between 100 and 110 mg/dl.
It has been shown that patients hospitalized for acute MI, with IFG, according to the previous American Diabetes Association (ADA) criteria (110 −126 mg/dl) had a significant higher risk of developing heart failure during their hospital stay. Since 2004, ADA has defined new criteria for IFG (fasting blood glucose between 100 and 126 mg/dl), because of evidence for increased cardiovascular risk in individuals with fasting glycemia (FG) above 100 mg/dl. However, so far the short-term prognosis after MI according to the new ADA criteria for IFG, and more particularly for the lower stage (100–110 mg/dl) has not been evaluated. Thus, we studied in-hospital outcomes according to the new criteria for IFG, in 2353 patients with acute MI from a large French regional MI registry. The diagnosis of fasting glucose abnormality was performed using the mean of the fasting glycemias obtained at day 4 and 5 after admission. Patients were classified as diabetics (D) (known diabetes or FG≥126 mg/dl), high IFG (110 ≤ FG <126 mg/dl), low IFG (100 ≤ FG<110 mg/dl) and normal fasting glycemia (NFG) (FG< 100 mg/dl). Among the 2353 patients, 968 (41.1%) were D, 262 ( 11.1%) were high IFG, 332 (14.1%) were low IFG and 791 (33.7%) were NFG. As compared to NFG patients, in-hospital cardiovascular mortality was increased in high IFG subjects (5.3% vs 1.8%, p=0.002) but not in low IFG subjects (1% vs 1.8%). In-hospital heart failure was increased in high IFG subjects (42% vs 20%, p<0.0001) but not in low IFG subjects (21% vs 20%). In multivariate analysis, after adjustment for age, gender, history of hypertension, anterior infaction, Killip class or LVEF, heart rate and blood pressure at admission, use of reperfusion therapy, high IFG, but not low IFG, was an independent factor for in-hospital mortality (OR: 2.33 [1.55–3.47], p=0.03) and for heart failure (OR: 1.70 [1.36–2.07], p=0.01). The threshold levels of FG that maximized the combined specificity and sensibility on the ROC curves were 114 mg/dl for predicting cardiovascular mortality and 112 mg/dl for predicting heart failure.
In conclusion: the high level of the new ADA criteria for IFG (110–126 mg/dl) is an independent factor for in-hospital CV mortality and heart failure after MI, when the low level of the new ADA criteria for IFG (100–110 mg/dl) is not.