Title |
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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Published in |
Acta Diabetologica, February 2018
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DOI | 10.1007/s00592-018-1114-2 |
Pubmed ID | |
Authors |
Sudipta Chattopadhyay, Anish George, Joseph John, Thozhukat Sathyapalan |
Abstract |
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. 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. 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. AGT is under-diagnosed on current guidelines. 2h-PG is a better predictor of prognosis compared to APG and FPG. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 25 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 7 | 28% |
Other | 2 | 8% |
Student > Doctoral Student | 1 | 4% |
Lecturer | 1 | 4% |
Student > Ph. D. Student | 1 | 4% |
Other | 1 | 4% |
Unknown | 12 | 48% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 9 | 36% |
Agricultural and Biological Sciences | 1 | 4% |
Nursing and Health Professions | 1 | 4% |
Psychology | 1 | 4% |
Materials Science | 1 | 4% |
Other | 0 | 0% |
Unknown | 12 | 48% |