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Acta Diabetologica

, Volume 55, Issue 5, pp 449–458 | Cite as

Two-hour post-challenge glucose is a better predictor of adverse outcome after myocardial infarction than fasting or admission glucose in patients without diabetes

  • Sudipta Chattopadhyay
  • Anish George
  • Joseph John
  • Thozhukat Sathyapalan
Original Article

Abstract

Aims

We evaluate prevalence of new abnormal glucose tolerance (AGT) in post-MI survivors without known diabetes (DM) if guidelines are followed and compare the ability of admission (APG), fasting (FPG) and 2-h post-load plasma glucose (2h-PG) to predict prognosis.

Methods

A total of 674 patients were followed up for 4 years for incidence of major adverse cardiovascular events (MACE) of cardiovascular death, non-fatal re-infarction or non-haemorrhagic stroke. Ability of models including APG, FPG and 2h-PG to predict MACE was compared.

Results

Of the total, 93–96% of impaired glucose tolerance and 64–75% of DM would be missed with current guidelines. MACE was higher in the upper quartiles of 2h-PG. When 2h-PG and FPG were included simultaneously in models, only 2h-PG predicted MACE (HR 1.12, CI 1.04–1.20, p = 0.0012), all cause mortality (HR 1.17, CI 1.05–1.30, p = 0.0039), cardiovascular mortality (HR 1.17, CI 1.02–1.33, p = 0.0205) and non-fatal MI (HR 1.10, CI 1.01–1.20, p = 0.0291). Adding 2h-PG significantly improved ability of models including FPG (χ2 = 16.01, df = 1, p = 0.0001) or FPG and APG (χ2 = 17.36, df = 1, p = 0.000) to predict MACE. Model including 2h-PG only had the lowest Akaike’s information criteria and highest Akaike weights suggesting that this was the best in predicting events. Adding 2h-PG to models including FPG or APG with other co-variates yielded continuous net reclassification improvement (NRI) of 0.22 (p = 0.026) and 0.27 (p = 0.005) and categorical NRI of 0.09 (p = 0.032) and 0.12 (p = 0.014), respectively. Adding 2 h-PG to models including only FPG, only APG and both yielded integrated discrimination improvement of 0.012 (p = 0.015), 0.022 (p = 0.001) and 0.013 (p = 0.014), respectively.

Conclusions

AGT is under-diagnosed on current guidelines. 2h-PG is a better predictor of prognosis compared to APG and FPG.

Keywords

Diabetes Myocardial infarction Acute coronary syndrome Oral glucose tolerance Impaired glucose tolerance Prognosis Glycated haemoglobin Glycosylated haemoglobin 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

All procedures performed in study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

Supplementary material

592_2018_1114_MOESM1_ESM.pdf (112 kb)
Supplementary material 1 (PDF 112 kb)

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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Sudipta Chattopadhyay
    • 1
  • Anish George
    • 2
  • Joseph John
    • 3
  • Thozhukat Sathyapalan
    • 4
  1. 1.Department of CardiologyMilton Keynes University HospitalMilton KeynesUK
  2. 2.Department of CardiologyScunthorpe General HospitalScunthorpeUK
  3. 3.Department of CardiologyCastle Hill HospitalKingston upon HullUK
  4. 4.Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical SchoolUniversity of HullKingston upon HullUK

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