Abstract 10261: The Long-term Impact of Newly Discovered Glucose Abnormalities in Patients With Acute Myocardial Infarction
Background and aims: Information on long-term prognostic implication of newly discovered glucose disturbances in patients with acute myocardial infarction (AMI) is lacking. We report on cardiovascular (CV) events during a decade of follow up of the Glucose tolerance in patients with Acute Myocardial Infarction (GAMI) cohort.
Methods: Patients with AMI but without known diabetes (n=167; at hospital discharge) and age- and gender matched controls (n=184) had their glucometabolic state classified by an oral glucose tolerance test (OGTT). A composite of CV events (first of non-fatal MI, stroke, severe congestive heart failure or CV mortality) were collected during a decade.
Results: Glucose tolerance was abnormal (AGT) in 68% of the patients (diabetes (DM) 33% and impaired glucose tolerance (IGT) 35%) and in 35% of the controls (DM 11%; IGT 24%). CV death (n=31,p= 0.031) and CV events (n= 72, p=0.0019) were more frequent in patients with AGT than those with NGT. A Cox proportional hazard regression analysis (including AGT, age, BMI, previous MI, heart failure, angina pectoris, CABG) identified AGT (HR;95%CI = 2·30; 1·24- 4·25, p=0·008) and previous MI (HR 2·39; 1·31- 4·35,p=0·004) as remaining predictors of CVE. Kaplan-Meier curves (see Figure) revealed that controls with NGT had the best and patients with AGT the most serious prognosis with a difference continuously increasing over time. MI patients with NGT had a similar event rate as controls with AGT.
Conclusion: An OGTT at hospital discharge after an AMI disclosed that the proportion of patients with previously unknown AGT was frequent and identifies individuals with enhanced risk for future CV events. An OGTT early in the course after AMI is recommended as a routine screening tool.
Figure: Red (patients, AGT), Blue (patients, NGT), Yellow (controls, AGT), Green (Controls, NGT)
- © 2013 by American Heart Association, Inc.