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

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A Correction to this article was published on 05 March 2018

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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.

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Change history

  • 05 March 2018

    Unfortunately, name of co-author “Thozhukat” was misspelled in the original publication and the same is corrected here. The original article has been corrected.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Milton Keynes University Hospital, Standing Way, Milton Keynes, MK6 5LD, UK

    Sudipta Chattopadhyay

  2. Department of Cardiology, Scunthorpe General Hospital, Cliff Gardens, Scunthorpe, UK

    Anish George

  3. Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, UK

    Joseph John

  4. Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull, UK

    Thozhukat Sathyapalan

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  1. Sudipta Chattopadhyay
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  2. Anish George
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  4. Thozhukat Sathyapalan
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Correspondence to Sudipta Chattopadhyay.

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Managed by Massimo Federici.

The original version of this article was revised: The co-author name “Thozhukat” was misspelled in the original publication and the same is corrected here.

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Chattopadhyay, S., George, A., John, J. et al. Two-hour post-challenge glucose is a better predictor of adverse outcome after myocardial infarction than fasting or admission glucose in patients without diabetes. Acta Diabetol 55, 449–458 (2018). https://doi.org/10.1007/s00592-018-1114-2

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