Post-load hyperglycemia as an important predictor of long-term adverse cardiac events after acute myocardial infarction: a scientific study.
BACKGROUND
Diabetes mellitus (DM) and impaired glucose tolerance (IGT) are risk factors for acute myocardial infarction (AMI). However, it is unknown whether hyperglycemic state is associated with increased major adverse cardiovascular events (MACE) after AMI. In this study, we evaluated the relationship between glucometabolic status and MACE in patients after AMI, and determined the critical level of 2 h post-load plasma glucose that may be used to predict MACE.


METHODS
AMI patients (n = 422) were divided into 4 groups as follows: normal glucose tolerance (NGT) group, IGT group, newly diagnosed DM (NDM) group, and previously known DM (PDM) group. MACE of the 4 groups were compared for 2 years from AMI onset.


RESULTS
The NDM group had a significantly higher event rate than the IGT and NGT groups and had a similar event rate curve to PDM group. The logistic models analyses revealed that 2 h post-load plasma glucose values of ≥160 mg/dL was the only independent predictor of long-term MACE after AMI (p = 0.028, OR: 1.85, 95% CI: 1.07-3.21). The 2-year cardiac event rate of patients with a 2 h post-load hyperglycemia of ≥160 mg/dL was significantly higher than that of patients with 2 h post-load glucose of <160 mg/dL (32.2% vs. 19.8%, p < 0.05) and was similar to that of PDM group (37.4%, p = 0.513).


CONCLUSIONS
NDM increases the risk of MACE after AMI as does PDM. Particularly, post-AMI patients with a 2 h post-load hyperglycemia ≥160 mg/dL may need adjunctive therapy after AMI.
Department of Cardiology, National Cardiovascular Center, Osaka, Japan.
Shuichi
S
Kitada
Yoritaka
Y
Otsuka
Nobuaki
N
Kokubu
Yoichiro
Y
Kasahara
Yu
Y
Kataoka
Teruo
T
Noguchi
Yoichi
Y
Goto
Genjirou
G
Kimura
Hiroshi
H
Nonogi
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D048909:Diabetes Complications / Q000097:blood / Q000209:etiology* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D044882:Glucose Metabolism Disorders / Q000097:blood / Q000150:complications* / Q000401:mortality; D005951:Glucose Tolerance Test; D006331:Heart Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000401:mortality; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000401:mortality; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D001786:Blood Glucose