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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

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

Authors

Sudipta Chattopadhyay

Anish George

Joseph John



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.

Citation

Chattopadhyay, S., George, A., John, J., & Sathyapalan, T. (2018). 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 Diabetologica, 55(5), 449–458. https://doi.org/10.1007/s00592-018-1114-2

Journal Article Type Article
Acceptance Date Feb 7, 2018
Online Publication Date Feb 15, 2018
Publication Date 2018-05
Deposit Date Feb 21, 2018
Publicly Available Date Oct 27, 2022
Journal Acta Diabetologica
Print ISSN 0940-5429
Electronic ISSN 1432-5233
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 55
Issue 5
Pages 449–458
DOI https://doi.org/10.1007/s00592-018-1114-2
Keywords Internal medicine; Endocrinology, Diabetes and metabolism; Endocrinology; General medicine
Public URL https://hull-repository.worktribe.com/output/618163
Publisher URL https://link.springer.com/article/10.1007%2Fs00592-018-1114-2#enumeration

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Copyright Statement
©2018 University of Hull

This is the accepted version of an article published at the DOI link.







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