Abnormal glucose regulation in patients with acute ST- elevation myocardial infarction-a cohort study on 224 patients

Eva C Knudsen, Ingebjørg Seljeflot, Michael Abdelnoor, Jan Eritsland, Arild Mangschau, Harald Arnesen, Geir O Andersen, Eva C Knudsen, Ingebjørg Seljeflot, Michael Abdelnoor, Jan Eritsland, Arild Mangschau, Harald Arnesen, Geir O Andersen

Abstract

Background: A high prevalence of impaired glucose tolerance and unknown type 2-diabetes in patients with coronary heart disease and no previous diagnosis of diabetes have been reported. The aims of the present study were to investigate the prevalence of abnormal glucose regulation (AGR) 3 months after an acute ST-elevation myocardial infarction (STEMI) in patients without known glucometabolic disturbance, to evaluate the reliability of a 75-g oral glucose tolerance test (OGTT) performed very early after an acute STEMI to predict the presence of AGR at 3 months, and to study other potential predictors measured in-hospital for AGR at 3 months.

Methods: This was an observational cohort study prospectively enrolling 224 STEMI patients treated with primary PCI. An OGTT was performed very early after an acute STEMI and was repeated in 200 patients after 3 months. We summarised the exact agreement observed, and assessed the observed reproducibility of the OGTTs performed in-hospital and at follow up. The patients were classified into glucometabolic categories defined according to the World Health Organisation criteria. AGR was defined as the sum of impaired fasting glucose, impaired glucose tolerance and type 2-diabetes.

Results: The prevalence of AGR at three months was 24.9% (95% CI 19.1, 31.4%), reduced from 46.9% (95% CI 40.2, 53.6) when measured in-hospital. Only, 108 of 201 (54%) patients remained in the same glucometabolic category after a repeated OGTT. High levels of HbA1c and admission plasma glucose in-hospital significantly predicted AGR at 3 months (p < 0.001, p = 0.040, respectively), and fasting plasma glucose was predictive when patients with large myocardial infarction were excluded (p < 0.001).

Conclusion: The prevalence of AGR in STEMI patients was lower than expected. HbA1c, admission plasma glucose and fasting plasma glucose measured in-hospital seem to be useful as early markers of longstanding glucometabolic disturbance. An OGTT performed very early after a STEMI did not provide reliable information on long-term glucometabolic state and should probably not be recommended.

Figures

Figure 1
Figure 1
Glucometabolic classification of 201 STEMI patients based on the results of an OGTT or fasting plasma glucose only, in-hospital and at 3 months. FPG: fasting plasma glucose, IFG: impaired fasting glucose, IGT: impaired glucose tolerance, NGR: normal glucose regulation, OGTT: oral glucose tolerance test, DM: type 2-diabetes.

References

    1. Norhammar A, Tenerz A, Nilsson G, Hamsten A, Efendic S, Ryden L, et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet. 2002;359:2140–2144. doi: 10.1016/S0140-6736(02)09089-X.
    1. Bartnik M, Ryden L, Ferrari R, Malmberg K, Pyorala K, Simoons M, et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J. 2004;25:1880–1890. doi: 10.1016/j.ehj.2004.07.027.
    1. Hu DY, Pan CY, Yu JM. The relationship between coronary artery disease and abnormal glucose regulation in China: the China Heart Survey. Eur Heart J. 2006;27:2573–2579. doi: 10.1093/eurheartj/ehl207.
    1. Andersen GO, Eritsland J, Aasheim A, Neuburger J, Knudsen EC, Mangschau A. Impaired glucose tolerance in patients with acute myocardial infarction. Tidsskr Nor Laegeforen. 2006;126:2264–2267.
    1. Bartnik M, Malmberg K, Norhammar A, Tenerz A, Ohrvik J, Ryden L. Newly detected abnormal glucose tolerance: an important predictor of long-term outcome after myocardial infarction. Eur Heart J. 2004;25:1990–1997. doi: 10.1016/j.ehj.2004.09.021.
    1. Ryden L, Standl E, Bartnik M, Van den BG, Betteridge J, de Boer MJ, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur Heart J. 2007;28:88–136. doi: 10.1093/eurheartj/ehm124.
    1. Deedwania P, Kosiborod M, Barrett E, Ceriello A, Isley W, Mazzone T, et al. Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2008;117:1610–1619. doi: 10.1161/CIRCULATIONAHA.107.188629.
    1. Bartnik M, Norhammar A, Ryden L. Hyperglycaemia and cardiovascular disease. J Intern Med. 2007;262:145–156. doi: 10.1111/j.1365-2796.2007.01831.x.
    1. Wallander M, Malmberg K, Norhammar A, Ryden L, Tenerz A. Oral glucose tolerance test: a reliable tool for early detection of glucose abnormalities in patients with acute myocardial infarction in clinical practice: a report on repeated oral glucose tolerance tests from the GAMI study. Diabetes Care. 2008;31:36–38. doi: 10.2337/dc07-1552.
    1. World Health Organization Department of Noncommunicable Disease Surveillance, Geneva Definition, Diagnosis and Classification of Diabetes Mellitus and its Complication. Report of a WHO Consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus. 2008.
    1. Hartmann A, Jenssen T, Midtvedt K, Reisaeter AV, Fauchald P, Henriksen T, et al. Protein-creatinine ratio–a simple method for proteinuria assessment in clinical practice. Tidsskr Nor Laegeforen. 2002;122:2180–2183.
    1. Gibbons RJ, Miller TD, Christian TF. Infarct size measured by single photon emission computed tomographic imaging with (99 m)Tc-sestamibi: A measure of the efficacy of therapy in acute myocardial infarction. Circulation. 2000;101:101–108.
    1. World Health Organization and International Diabetes Federation Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia. Report of a WHO/IDF Consultation. 2005. pp. 1–46.
    1. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research Principles and quantitative methods. New York: Van Nostrand Reinhold Company Inc; 1982.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–1457. doi: 10.1016/S0140-6736(07)61602-X.
    1. Abbud ZA, Shindler DM, Wilson AC, Kostis JB. Effect of diabetes mellitus on short- and long-term mortality rates of patients with acute myocardial infarction: a statewide study. Myocardial Infarction Data Acquisition System Study Group. Am Heart J. 1995;130:51–58. doi: 10.1016/0002-8703(95)90235-X.
    1. The DECODE Study Group on behalf of the European Diabetes Epidemiology Group Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med. 2001;161:397–405. doi: 10.1001/archinte.161.3.397.
    1. Ko GT, Chan JC, Woo J, Lau E, Yeung VT, Chow CC, et al. The reproducibility and usefulness of the oral glucose tolerance test in screening for diabetes and other cardiovascular risk factors. Ann Clin Biochem. 1998;35:62–67.
    1. Kobberling J, Kerlin A, Creutzfeldt W. The reproducibility of the oral glucose tolerance test over long (5 years) and short periods (1 week) Klin Wochenschr. 1980;58:527–530. doi: 10.1007/BF01477070.
    1. Tenerz A, Norhammar A, Silveira A, Hamsten A, Nilsson G, Ryden L, et al. Diabetes, insulin resistance, and the metabolic syndrome in patients with acute myocardial infarction without previously known diabetes. Diabetes Care. 2003;26:2770–2776. doi: 10.2337/diacare.26.10.2770.
    1. Lankisch M, Futh R, Gulker H, Lapp H, Bufe A, Haastert B, et al. Screening for undiagnosed diabetes in patients with acute myocardial infarction. Clin Res Cardiol. 2008;97:753–759. doi: 10.1007/s00392-008-0674-5.

Source: PubMed

3
Předplatit