Impaired Glucose Tolerance or Newly Diagnosed Diabetes Mellitus Diagnosed during Admission Adversely Affects Prognosis after Myocardial Infarction: An Observational StudyReport as inadecuate




Impaired Glucose Tolerance or Newly Diagnosed Diabetes Mellitus Diagnosed during Admission Adversely Affects Prognosis after Myocardial Infarction: An Observational Study - Download this document for free, or read online. Document in PDF available to download.

Objective

To investigate the prognostic effect of newly diagnosed diabetes mellitus NDM and impaired glucose tolerance IGT post myocardial infarction MI.

Research Design and 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.

Conclusion

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.



Author: Anish George, Raghav T. Bhatia, Gill L. Buchanan, Anne Whiteside, Robert S. Moisey, Stephen F. Beer, Sudipta Chattopadhyay, Thozh

Source: http://plos.srce.hr/



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