TY - JOUR
T1 - Newly detected abnormal glucose regulation and long-term prognosis after acute myocardial infarction
T2 - Comparison of an oral glucose tolerance test and glycosylated haemoglobin A1c
AU - Pararajasingam, Gokulan
AU - Høfsten, Dan Eik
AU - Løgstrup, Brian Bridal
AU - Egstrup, Michael
AU - Henriksen, Finn Lund
AU - Hangaard, Jørgen
AU - Egstrup, Kenneth
N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background An oral glucose tolerance test (OGTT) and/or glycosylated haemoglobin A1c (HbA1c) in patients with acute myocardial infarction (AMI) identify patients with increased mortality risk, but no comparison of the long-term prognostic values has yet been investigated. Methods This study was a prospective cohort enrolling patients with AMI between 2002 until 2008 and follow-up until 1st October, 2012. Patients without known diabetes mellitus (DM) underwent an OGTT. Seventy-nine patients with known DM did not have an OGTT performed. Primary endpoint was all-cause mortality. We included 548 patients with AMI, of whom 469 underwent a standardized OGTT and were stratified according to OGTT and HbA1c. Results During 9.8 years of follow-up, 179 (33%) patients died. In patients having increased HbA1c ≥ 6.5%, a significantly increased mortality was observed (Hazard Ratio (HR) 1.60 [1.09-2.34]). However, when adjusting for known DM, no significance was detected. An OGTT did not show a significantly increased mortality, if used separately. A combined estimate showed a significantly increased mortality in patients categorized as newly diagnosed DM by OGTT and HbA1c < 6.5% (HR 1.56 [95% CI 1.07-2.30]) compared to patients categorized as normal/impaired fasting glycaemia/impaired glucose tolerance by OGTT and HbA1c < 6.5%. Approximately 50% of the patients with newly diagnosed DM by OGTT were only detected due to 2-hour post-load glucose values. Conclusion An OGTT is recommended in AMI patients without known DM and HbA1c < 6.5%. Patients categorized as newly diagnosed DM by OGTT although HbA1c < 6.5% share the same high risk of mortality as patients with HbA1c ≥ 6.5%.
AB - Background An oral glucose tolerance test (OGTT) and/or glycosylated haemoglobin A1c (HbA1c) in patients with acute myocardial infarction (AMI) identify patients with increased mortality risk, but no comparison of the long-term prognostic values has yet been investigated. Methods This study was a prospective cohort enrolling patients with AMI between 2002 until 2008 and follow-up until 1st October, 2012. Patients without known diabetes mellitus (DM) underwent an OGTT. Seventy-nine patients with known DM did not have an OGTT performed. Primary endpoint was all-cause mortality. We included 548 patients with AMI, of whom 469 underwent a standardized OGTT and were stratified according to OGTT and HbA1c. Results During 9.8 years of follow-up, 179 (33%) patients died. In patients having increased HbA1c ≥ 6.5%, a significantly increased mortality was observed (Hazard Ratio (HR) 1.60 [1.09-2.34]). However, when adjusting for known DM, no significance was detected. An OGTT did not show a significantly increased mortality, if used separately. A combined estimate showed a significantly increased mortality in patients categorized as newly diagnosed DM by OGTT and HbA1c < 6.5% (HR 1.56 [95% CI 1.07-2.30]) compared to patients categorized as normal/impaired fasting glycaemia/impaired glucose tolerance by OGTT and HbA1c < 6.5%. Approximately 50% of the patients with newly diagnosed DM by OGTT were only detected due to 2-hour post-load glucose values. Conclusion An OGTT is recommended in AMI patients without known DM and HbA1c < 6.5%. Patients categorized as newly diagnosed DM by OGTT although HbA1c < 6.5% share the same high risk of mortality as patients with HbA1c ≥ 6.5%.
KW - Journal Article
KW - Review
UR - http://www.scopus.com/inward/record.url?scp=84963705408&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2016.03.199
DO - 10.1016/j.ijcard.2016.03.199
M3 - Review
C2 - 27085117
SN - 0167-5273
VL - 214
SP - 310
EP - 315
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -