title: Newly detected abnormal glucose regulation and long-term prognosis after acute myocardial infarction: Comparison of an oral glucose tolerance test and glycosylated haemoglobin A1c.
abstract: 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 9.8years 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.
  
  
  CONCLUSIONS
  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%.
authors.affiliation: Department of Medical Research, OUH Svendborg Hospital, Valdemarsgade 53, 5700 Svendborg, Denmark. Electronic address: gokulan.pararajasingam@rsyd.dk.
authors.forename: Gokulan
authors.initials: G
authors.lastname: Pararajasingam
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
authors.forename: Dan Eik
authors.initials: DE
authors.lastname: Høfsten
authors.affiliation: Department of Cardiology, Aarhus University Hospital Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
authors.forename: Brian Bridal
authors.initials: BB
authors.lastname: Løgstrup
authors.affiliation: Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Egstrup
authors.affiliation: Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark.
authors.forename: Finn Lund
authors.initials: FL
authors.lastname: Henriksen
authors.affiliation: Department of Endocrinology, OUH Svendborg Hospital, Valdemarsgade 53, 5700 Svendborg, Denmark.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Hangaard
authors.affiliation: Department of Medical Research, OUH Svendborg Hospital, Valdemarsgade 53, 5700 Svendborg, Denmark.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Egstrup
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D018149:Glucose Intolerance / Q000097:blood; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: acute myocardial infarction; follow-up; glycosylated haemoglobin; mortality; oral glucose tolerance test