Abstract 14054: Higher Mortality Among Acute Myocardial Infarction Patients with Abnormal Glucose Metabolism During Long-Term Follow-Up

Abstract

Background: Several studies have identified abnormal glucose metabolism as a significant risk factor for mortality after acute myocardial infarction (AMI) during short- and intermediate term follow-up. This study aimed to assess the long-term impact of glucometabolic status on all-cause mortality.

Methods and results: From November 2002 to August 2008, we included 546 patients during hospitalization for AMI. 79 (15%) patients had a previous diagnosis of diabetes mellitus (DM). Within a median of 3 days (interquartile range: 1 - 4 days) following AMI, patients without known DM underwent a standardized oral glucose tolerance test (OGTT). Using World Health Organization (WHO) criteria, they were categorised as having normal glucose tolerance, impaired glucose tolerance (IGT) or newly detected DM. During a median follow-up of 68 months, 166 (30%) patients died. After adjustment for age, gender, smoking status, hypertension, hypercholesterolemia, previous myocardial infarction, body mass index, systolic and diastolic blood pressure, left ventricular systolic function, as well as baseline HbA1c, mortality was significantly higher both among patients with new DM (HR 2.3; 95% CI 1.1 - 4.7; P=0.02), and patients with known DM (HR 3.2; 95% CI 1.3 - 8.2; P=0.01). In patients with IGT, no increase in mortality-risk was observed (HR 1.2; 95% CI 0.6 - 2.5; P=0.65). In patients with new DM based on OGTT, only 18 (15.8%) fulfilled the recently adapted WHO criteria for new DM of HbA1c ≥ 6.5%.

Conclusion: Long-term mortality was significantly higher in AMI patients with both new DM and known DM compared to patients with normal glucose metabolism. New DM diagnosed by OGTT predicted outcome independently of HbA1c levels at baseline, as well as other important clinical risk factors.