Abnormal glucose regulation in patients with acute ST- elevation myocardial infarction-a cohort study on 224 patients
Eva C Knudsen1, Ingebjørg Seljeflot, Michael Abdelnoor
1Center for Clinical Heart Research, Ullevål University Hospital, University of Oslo, Oslo, Norway. evacecilie.knudsen@ulleval.no
Insights
Abnormal glucose regulation (AGR) affects nearly a quarter of ST-elevation myocardial infarction (STEMI) patients. In-hospital HbA1c and glucose levels predict long-term AGR, but early oral glucose tolerance tests are unreliable.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Background:
- Coronary heart disease patients often have undiagnosed impaired glucose tolerance or type 2 diabetes.
- ST-elevation myocardial infarction (STEMI) is a critical condition where glucose metabolism disturbances are common but often overlooked.
- Investigating abnormal glucose regulation (AGR) post-STEMI is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of AGR three months after STEMI in patients without prior diabetes diagnosis.
- To assess the reliability of an early oral glucose tolerance test (OGTT) in predicting 3-month AGR.
- To identify in-hospital predictors of AGR at the 3-month follow-up.
Main Methods:
- An observational cohort study included 224 STEMI patients treated with primary percutaneous coronary intervention (PCI).
- An initial 75-g oral glucose tolerance test (OGTT) was performed early post-STEMI, with a repeat OGTT at 3 months for 200 patients.
- Patients were categorized using World Health Organization criteria; AGR encompassed impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes.
Main Results:
- The prevalence of AGR at 3 months was 24.9%, significantly lower than the 46.9% detected in-hospital.
- Only 54% of patients maintained their glucometabolic classification between the early and 3-month OGTTs, indicating poor reproducibility.
- In-hospital HbA1c and admission plasma glucose were significant predictors of 3-month AGR (p < 0.001 and p = 0.040, respectively).
Conclusions:
- AGR prevalence in STEMI patients is lower at 3 months than initially suggested by early testing.
- In-hospital HbA1c and glucose levels serve as valuable early indicators of persistent glucometabolic disturbances.
- Early OGTTs post-STEMI lack reliability for assessing long-term glucose regulation and are not recommended.
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.
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