[Abnormal glucose tolerance and long-term prognosis in patients with acute myocardial infarction].

OBJECTIVE

to assess clinical outcomes and cardiovascular events during long-term follow-up after acute myocardial infarction (AMI) in patients (pts) with newly detected abnormal glucose tolerance (AGT).

METHODS

Consecutive AMI pts (n=391, 24.3% with diabetes mellitus [DM]) were enrolled in the study. Pts with no DM underwent an oral glucose tolerance test (OGTT) at discharge (around 12-th day). All pts were divided into 3 groups: group I - pts with normal glucose tolerance (NGT), group II - pts with AGT, including impaired glucose tolerance (IGT) and newly diagnosed DM (NDM), group III - pts with previously known DM. General and cardiovascular mortality, adverse cardiovascular events during long-term follow-up (26.8+/-6 months) were studied.

RESULTS

According to the OGTT 67.9% pts had NGT and 32.1% had AGT (28.7% IGT and 3.4% NDM). Pts with disturbances of glucose metabolism were older, had abdominal obesity, more frequently had Killip class >2 on admission, as well as reduced ejection fraction, left ventricular aneurism and progression of chronic heart failure at discharge. Cardiovascular and general mortality during follow-up were significantly higher in pts with AGT and DM compared to NGT (27.4 vs. 22.1 vs 11.1%, p=0.002, and 23.2 vs. 20.2 vs 10.1%, p<0.05, respectively). The incidence of recurrent nonfatal MI and stroke were similar in the three groups, however the proportion of subjects with heart failure NYHA class >2, revascularization procedures, hospitalization due to cardiovascular events was higher in pts with abnormalities of carbohydrate metabolism.

CONCLUSIONS

Abnormal glucose tolerance (IGT and NDM) has high prevalence in AMI patients without known DM, is a major risk factor for future cardiovascular events and is associated with unfavorable long term prognosis after MI.