title: Impaired Glucose Tolerance or Newly Diagnosed Diabetes Mellitus Diagnosed during Admission Adversely Affects Prognosis after Myocardial Infarction: An Observational Study.
abstract: OBJECTIVE
  To investigate the prognostic effect of newly diagnosed diabetes mellitus (NDM) and impaired glucose tolerance (IGT) post myocardial infarction (MI).
  
  
  METHODS
  Retrospective cohort study of 768 patients without preexisting diabetes mellitus post-MI at one centre in Yorkshire between November 2005 and October 2008. Patients were categorised as normal glucose tolerance (NGT n = 337), IGT (n = 279) and NDM (n = 152) on pre- discharge oral glucose tolerance test (OGTT). Primary end-point was the first occurrence of major adverse cardiovascular events (MACE) including cardiovascular death, non-fatal MI, severe heart failure (HF) or non-haemorrhagic stroke. Secondary end-points were all cause mortality and individual components of MACE.
  
  
  RESULTS
  Prevalence of NGT, impaired fasting glucose (IFG), IGT and NDM changed from 90%, 6%, 0% and 4% on fasting plasma glucose (FPG) to 43%, 1%, 36% and 20% respectively after OGTT. 102 deaths from all causes (79 as first events of which 46 were cardiovascular), 95 non fatal MI, 18 HF and 9 non haemorrhagic strokes occurred during 47.2 ± 9.4 months follow up. Event free survival was lower in IGT and NDM groups. IGT (HR 1.54, 95% CI: 1.06-2.24, p = 0.024) and NDM (HR 2.15, 95% CI: 1.42-3.24, p = 0.003) independently predicted MACE free survival. IGT and NDM also independently predicted incidence of MACE. NDM but not IGT increased the risk of secondary end-points.
  
  
  CONCLUSIONS
  Presence of IGT and NDM in patients presenting post-MI, identified using OGTT, is associated with increased incidence of MACE and is associated with adverse outcomes despite adequate secondary prevention.
authors.affiliation: Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, United Kingdom.
authors.forename: Anish
authors.initials: A
authors.lastname: George
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, United Kingdom.
authors.forename: Raghav T
authors.initials: RT
authors.lastname: Bhatia
authors.affiliation: Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, United Kingdom.
authors.forename: Gill L
authors.initials: GL
authors.lastname: Buchanan
authors.affiliation: Department of Diabetes and Endocrinology, Scunthorpe General Hospital, Scunthorpe, United Kingdom.
authors.forename: Anne
authors.initials: A
authors.lastname: Whiteside
authors.affiliation: Department of Diabetes and Endocrinology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Moisey
authors.affiliation: Department of Diabetes and Endocrinology, Scunthorpe General Hospital, Scunthorpe, United Kingdom.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Beer
authors.affiliation: Department of Cardiology, Scunthorpe General Hospital, Scunthorpe, United Kingdom.
authors.forename: Sudipta
authors.initials: S
authors.lastname: Chattopadhyay
authors.affiliation: Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom.
authors.forename: Thozhukat
authors.initials: T
authors.lastname: Sathyapalan
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, United Kingdom.
authors.forename: Joseph
authors.initials: J
authors.lastname: John
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D048909:Diabetes Complications / Q000175:diagnosis; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D005260:Female; D018149:Glucose Intolerance / Q000150:complications; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D010343:Patient Admission; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose