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November 16, 2015PLoS ONEOpen Access

Impaired Glucose Tolerance or Newly Diagnosed Diabetes Mellitus Diagnosed during Admission Adversely Affects Prognosis after Myocardial Infarction: An Observational Study

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Why the study?

Does newly diagnosed diabetes mellitus or impaired glucose tolerance increase the risk of major adverse cardiovascular events in patients post-myocardial infarction?

Population

768 patients without preexisting diabetes mellitus post-myocardial infarction at one centre in Yorkshire…

Comparison

Newly diagnosed diabetes mellitus or impaired… vs Normal glucose tolerance diagnosed on…

Design

Cohort

Follow-up

47.2 ± 9.4 months

Key result

Newly diagnosed diabetes mellitus (HR 2.15) and impaired glucose tolerance (HR 1.54) independently increased the risk of major adverse cardiovascular events compared to normal glucose tolerance post-myocardial infarction.

Authors

AGAnish GeorgeRBRaghav BhatiaGBGill Louise Buchanan

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Overview

Routine OGTT post-MI may aid risk stratification; leaves open whether intervention reduces MACE in this group.

Study Design

Type

Cohort (n=768)

Multicenter

No

Structured PICO

Does newly diagnosed diabetes mellitus or impaired glucose tolerance increase the risk of major adverse cardiovascular events in patients post-myocardial infarction?

P
Population
768 patients without preexisting diabetes mellitus admitted with myocardial infarction, followed for a mean of 47.2 months.
E
Exposure
Newly diagnosed diabetes mellitus (NDM) or impaired glucose tolerance (IGT) diagnosed on pre-discharge oral glucose tolerance test (OGTT)
C
Comparator
Normal glucose tolerance (NGT) diagnosed on pre-discharge oral glucose tolerance test (OGTT)
O
Outcome
First occurrence of major adverse cardiovascular events (MACE) including cardiovascular death, non-fatal MI, severe heart failure (HF) or non-haemorrhagic strokecomposite

Main Result

Hazard Ratio: 2.15 (95% CI 1.42–3.24)

Absolute Event Rate: 32.2% vs 14.2%

p-value: p=0.003

Newly diagnosed diabetes mellitus and impaired glucose tolerance identified via pre-discharge OGTT are strong independent predictors of major adverse cardiovascular events in patients post-myocardial infarction.

Limitations

  • Retrospective analysis of prospectively collected data from a single centre
  • Did not explore the interaction between acute revascularisation and post-challenge hyperglycaemia or post-discharge management
  • OGTT was not repeated pre- or post-discharge, so random fluctuation or stress-associated hyperglycaemia could not be ruled out
  • Observational longitudinal cohort study using retrospective analysis of prospectively collected data from a single centre
  • OGTT was not repeated pre- or post-discharge, so it is uncertain whether random fluctuation in glycaemia or stress associated hyperglycaemia affected results

Cite This Study

George et al. (2015) conducted a cohort in Myocardial infarction (n=768). Newly diagnosed diabetes mellitus (NDM) vs. Normal glucose tolerance (NGT) was evaluated on First occurrence of major adverse cardiovascular events (MACE) including cardiovascular death, non-fatal MI, severe heart failure or non-haemorrhagic stroke (HR 2.15, 95% CI 1.42-3.24, p=0.003). Newly diagnosed diabetes mellitus (HR 2.15) and impaired glucose tolerance (HR 1.54) independently increased the risk of major adverse cardiovascular events compared to normal glucose tolerance post-myocardial infarction.

synapsesocial.com/papers/6a20174d40c8e71b0ba1a488https://doi.org/10.1371/journal.pone.0142045
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