L.A. David.Influence of newly diagnosed abnormal glucose tolerance on prognosis in patients with acute myocardial infarction

The aim – to evaluate the clinical outcomes and cardiovascular events during long-term follow-up after acute myocardial infarction (AMI) in patients with newly detected abnormal glucose tolerance (AGT).
Material and methods. 391 consecutive AMI pts were enrolled in the study, 24.3 % – with diabetes mellitus (DM). Subjects with no DM underwent an oral glucose tolerance test (OGTT) at discharge (around the 12th day). All patients were divided into 3 groups: I – patients with normal glucose tolerance (NGT), II – patients with AGT, including impaired glucose tolerance (IGT) and newly diagnosed DM (NDM), III – patients with previously known DM. General and cardiovascular mortality, adverse cardiovascular events during long-term follow-up (54.6±1.4 months) were studied.
Results. According to the OGTT 57.4 % patients had NGT and 42.6 % had AGT (35.8 % IGT and 6.8 % NDM). Subjects with abnormalities of glucose metabolism were older, had abdominal obesity, were more likely to be in Killip class > ІІ at admission, revealed higher frequency of reduced left ventricular ejection fraction (LVEF) and progression of heart failure in hospital and at discharge. Parameters of cardiovascular and general mortality during follow-up were significantly higher in patients with AGT and DM compared to NGT (47.9 % vs 38.1 % vs 24.1 % and 42.7 % vs 36,5 % vs 21.8 %; Р<0.001 for both comparisons). The incidences of recurrent nonfatal MI and stroke were similar in the three groups; however the proportion of subjects with heart failure NYHA class > 2, hospitalization due to cardiovascular events was higher in pts with glucometabolic abnormalities. Age, history of heart failure, LVEF and 2-hour glucose level in OGTT were independent predictors of mortality in the post infarction period during long-term follow-up.
Conclusions. Abnormal glucose tolerance is highly prevalent in AMI patients without known DM, is associated with unfavorable postinfarction prognosis, high prevalence of cardiovascular events and mortality.

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