Kardiologia polska 2016 Oct 07() doi 10.5603/KP.a2016.0128
Glucometabolic status (GS) in patients with acute myocardial infarction (AMI) has impact on prognosis, however may change over time.
To evaluate prognosis after AMI treated invasively with respect to changes in GS evaluated by oral glucose tolerance test at discharge and at mid-term follow-up visit (FU-visit).
GS was assessed by 2-hour post load glycaemia and defined as abnormal glucose tolerance (AGT) or normal glucose tolerance (NGT). Out of 454 in-hospital AMI survivors 368 (81%) patients completed FU-visit and were divided into four groups with respect to GS at discharge and FU-visit. Group 1-AGT at discharge and FU-visit (n=101); group 2-AGT at discharge and NGT at FU-visit (n=48); group 3-NGT at discharge and AGT at FU-visit (n=114); group 4-NGT at discharge and FU-visit (n=105). All-cause mortality was compared between groups with log-rank test.
Median time from AMI to FU-visit was 7 months. Median remote follow-up duration after AMI was 31 months. Two-hour post load glycaemia was significantly higher in patients with confirmed AGT at FU-visit than in other groups. Mortality was higher in group 1 (11.9%) than in group 2 (2.1%; p=0.034) and group 4 (2.9%; p=0.009). Mortality rates between group 2 and 4 were similar (2.1% vs. 2.9%; p=0.781). There was no significant difference in mortality between group 1 and group 3 (11.9% vs. 6.1%; p=0.114). Mortality in group 3 was over 2-fold higher than in group 4, however this difference was statistically non-significant (6.1% vs. 2.9%; p=0.247).
Prognosis for patients with confirmed abnormal glucose tolerance was unfavorable, however patients with abnormal glucose tolerance at discharge in whom glucometabolic status improved had similar mortality to subjects with persistent normal glucose tolerance. The major clinical implication from this study is finding that reassessment of glucometabolic status by repeated oral glucose tolerance test has significant prognostic value and makes initial risk stratification performed at discharge more reliable.