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OBJECTIVE -In some studies, fasting and postload glycemia are a strong predictor of coronary events and cardiac death. Therefore, we investigated the relationship between fasting and postload glucose concentrations and coronary status in 363 men referred for coronary arteriography without a previous history of diabetes.RESEARCH DESIGN AND METHODS -A total of 363 men (mean age 53.0 Ϯ 9.1 years, mean BMI 27.9 Ϯ 3.7 kg/m 2 ) with positive results of exercise testing were included in the study. A standard oral glucose tolerance test (OGTT) with glucose and insulin estimations was performed on all subjects. The concentrations of total cholesterol, HDL cholesterol, triglycerides, and HbA 1c were also measured. All patients were divided into four groups, according to coronary status: no changes in coronary arteries (group 0, n ϭ 61), one-vessel disease (group I, n ϭ 113), two-vessel disease (group II, n ϭ 116), and three-vessel disease (group III, n ϭ 73).RESULTS -The highest postload glucose concentrations were observed in group III. Also, insulin concentrations and HbA 1c increased with the progression of atherosclerotic lesions in the coronary arteries. Based on results of the OGTT, 16% of the patients (n ϭ 59) fulfilled the World Health Organization criteria for type 2 diabetes and 36% of the patients (n ϭ 131) met criteria for impaired glucose tolerance. Significant correlations were observed between the number of involved vessels and postload glycemia, HbA 1c , fasting insulin, and postload insulin. The multiple stepwise regression analysis showed that age, total cholesterol, and HDL cholesterol independently correlated with the number of involved vessels. CONCLUSIONS -We conclude that patients with advanced changes in the coronary arteries experience more pronounced metabolic disturbances. Postload glycemia could be an important predictor of nondiagnosed disturbances of glucose metabolism.

A group of Polish experts in cardiology and emergency medicine, encouraged by the European Society of Cardiology (ESC) guidelines, have recently published common recommendations for medical emergency teams regarding the pre-hospital management of patients with acute coronary syndrome. Due to the recent publication of the 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation and 2017 focused update on dual antiplatelet therapy in coronary artery disease the current panel of experts decided to update the previous standpoint. Moreover, new data coming from studies presented after the previous document was issued were also taken into consideration.

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