Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes

Chattopadhyay, Sudipta; George, Anish; John, Joseph; Sathyapalan, Thozhukat

Abstract

© The Author(s) 2019. Background: Effect of pre-diabetes mellitus on post-myocardial infarction prognosis is unclear. Methods: Retrospective cohort analysis of 1056 myocardial infarction survivors with fasting plasma glucose and 2-h post-load plasma glucose measured. Major adverse cardiovascular events included death, non-fatal reinfarction and ischaemic stroke. Cox proportional hazard regression identified predictors of event-free survival. Continuous net reclassification improvement and integrated discrimination improvement determined the added predictive value of glycaemic indices. Results: Major adverse cardiovascular events occurred in 25.1% and 16.4% patients with and without pre-diabetes mellitus (hazard ratio with pre-diabetes mellitus: 1.56; 95% confidence interval: 1.17–2.08; p = 0.003) in the whole cohort and in 24.1% and 17.2% patients (hazard ratio with pre-diabetes mellitus, 1.43; 95% confidence interval: 1.03–1.98; p = 0.033) in the matched cohort, respectively. Pre-diabetes mellitus predicted major adverse cardiovascular events–free survival in whole (hazard ratio: 1.39; 95% confidence interval: 1.03–1.89; p = 0.033) and matched cohorts (hazard ratio: 1.42; 95% confidence interval: 1.01–1.99; p = 0.043). The 2-h post-load plasma glucose, but not fasting plasma glucose, predicted major adverse cardiovascular events–free survival in the whole (hazard ratio: 1.16; 95% confidence interval: 1.07–1.26; p < 0.0001) and matched cohorts (hazard ratio: 1.20; 95% confidence interval: 1.09–1.31; p < 0.0001). Adding 2-h post-load plasma glucose to models containing fasting plasma glucose, significantly improved net reclassification improvement and integrated discrimination improvement for both cohorts, but not vice versa. Conclusion: Pre-diabetes mellitus predicts major adverse cardiovascular events after myocardial infarction. The 2-h post-load plasma glucose predicts prognosis better than fasting plasma glucose in these patients.

Citation

Chattopadhyay, S., George, A., John, J., & Sathyapalan, T. (2019). Pre-diabetes mellitus newly diagnosed after myocardial infarction adversely affects prognosis in patients without known diabetes. Diabetes and Vascular Disease Research, 16(6), 489-497. https://doi.org/10.1177/1479164119845561

• Journal Article Type: Article
• Online Publication Date: May 2, 2019
• Publication Date: Nov 1, 2019
• Deposit Date: May 15, 2021
• Journal: Diabetes and Vascular Disease Research
• Print ISSN: 1479-1641
• Electronic ISSN: 1752-8984
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 16
• Issue: 6
• Pages: 489-497
• DOI: https://doi.org/10.1177/1479164119845561
• Keywords: Acute coronary syndrome; Myocardial infarction; Diabetes; Oral glucose tolerance test; Impaired fasting glucose; Impaired glucose tolerance
• Public URL: https://hull-repository.worktribe.com/output/3624897