Impact of Newly Diagnosed Abnormal Glucose Tolerance on Long-Term Prognosis in Patients With Acute Myocardial Infarction

Abstract

ompared to individuals without diabetes mellitus (DM), DM patients have approximately a 2-fold higher risk of short-term mortality after acute myocardial infarction (AMI). 1,2 In the current reperfusion era, over 90% of DM patients survive the early 30-day period; however, these patients are prone to markedly-increased mortality after 6 th months. 3,4 The results of several clinical studies indicate that even people with pre-diabetic conditions, such as impaired glucose tolerance (IGT), have increased risks for cardiovascular disease. 5-8 A recent metaregression analysis reported a continuous relationship between 2h-postchallenge glucose levels and cardiovascular risk below the diabetic threshold, and there is growing epidemiological evidence for the association of postchallenge hyperglycemia and macrovascular complications. [9][10][11][12][13] Recently, the Glucose Tolerance in Patients with Acute Myocardial Infarction (GAMI) study revealed that abnormal glucose tolerance, determined by the presence of postchallenge hyperglycemia, was common among patients with AMI and is a risk factor for future cardiovascular events. 14,15 However, the impact of newly-diagnosed abnormal glucose tolerance on the long-term prognosis after AMI has not been fully demonstrated. The aim of the present study, therefore, was to determine whether newlydiagnosed abnormal glucose tolerance affects long-term clinical outcomes after AMI relative to AMI patients with normal glucose tolerance or with previously diagnosed DM in the current clinical settings. Methods Study PatientsWe enrolled 384 consecutive patients with AMI admitted to the coronary care unit of Kobe General Hospital, Japan, from August 1997 to December 2000. We excluded all individuals who were older than 80 years old, or who had serum creatinine concentrations higher than 2.0 mg/dl or other inhospital major adverse clinical events, including cardiogenic shock and emergency coronary artery bypass grafting. Of the 384 consecutive patients screened, 109 patients were excluded due to in-hospital death (n=34), stroke (n=2), emergency coronary artery bypass surgery (n=22), left ventricular (LV) reconstruction surgery (n=2), non-fatal LV rupture (n=5), recurrent percutaneous coronary intervention (PCI; n=3), concomitant disease (n=6, idiopathic dilated cardiomyopathy, neoplasm, schizophrenia, hypoxic brain damage), chronic renal failure (n=7), age over 80 years old (n=8) and unwillingness to enter the study (n=20). The study protocol was approved by the Committee for the Protection of Human Subjects in Research at Kobe General Hospital. Written informed consent was obtained from all individuals. Background Newly-diagnosed diabetes mellitus (DM) and impaired glucose tolerance are common among patients with acute myocardial infarction (AMI). However, its significance on long-term clinical outcomes in those patients remains unclear. The present study was designed to determine whether such abnormalities after AMI affect long-term clinical outcomes. Methods and ResultsTwo-hundred and ...

Diabetes Mellitus Does Not Affect Jugular Bulb Oxygen Saturation in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery

“…16,17 One of the possible causes of increased postoperative neurologic deficits in diabetic patients is impaired cerebrovascular circulatory and vasodilatory reserve. 18,19 Hyperglycemia leads to impaired vascular function by altering endothelial cell function.…”

Perfil glicometabólico inicial em pacientes com síndrome coronariana aguda e síndrome metabólica

“…Recently, studies aimed to evaluate the long-term prognosis of IGT or newly-diagnosed DM after myocardial infarction have identified these glucometabolic abnormalities after OGTT as the strongest predictors of death and major cardiovascular events [22][23][24] .…”

Impaired Glucose Tolerance, Impaired Fasting Glucose and Cardiovascular Risk

“…1 The cardiovascular event-free survival rate in the impaired glucose tolerance (IGT) group and the group with newly diagnosed diabetes were 73% and 67%, respectively, at 5-year follow up. They combined these 2 groups as the abnormal glucose tolerance group and the event-free survival rate in the combined group was 70%, which was significantly lower than the rate (87%) in the normal glucose tolerance group.…”

“…However, the p-values of the hazard ratio for abnormal glucose tolerance and fasting plasma glucose were 0.0068 and 0.001, respectively, in their univariate Cox regression analysis. 1 Recently, the American Diabetes Association revised the cut point of impaired fasting glucose (IFG) as 100 mg/dl 2 and the International Diabetes Federation 3 and the American Heart Association 4 adopted this cut point. Therefore, they should evaluate not only IGT but also old and revised IFG as risk factors for future cardiovascular events as done by Kanaya et al 5 I deeply appreciate if they would also study C-reactive protein (CRP) as a risk factor for future cardiovascular events as suggested by Matsushita et al in their cross-sectional study.…”