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Basal glucometabolic status has an impact on long-term prognosis following an acute myocardial infarction in non-diabetic patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
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2003 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 254, no 5, 494-503 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Patients with diabetes are known to have a worse prognosis after an acute myocardial infarction (AMI) compared with non-diabetic patients. The primary aim of this study was to investigate the effect of glucometabolic status on long-term prognosis in non-diabetic patients with an AMI. The second aim was to evaluate the extent to which blood glucose levels at admission depended on acute stress, assessed as serum cortisol, previous glucometabolic status, measured as haemoglobin A1c (HbA1c), or both.

DESIGN: In a prospective study of patients with an AMI, blood glucose, HbA1c and cortisol were measured at admission. Fasting blood glucose was determined before discharge and also afterwards, if necessary, for classification. Patients were followed-up for 5.5 years.

SUBJECTS: Of the 305 consecutive patients 24% were diagnosed as diabetic and 76% as non-diabetic.

MAIN OUTCOME MEASURES: Death or non-fatal myocardial re-infarction.

RESULTS: In non-diabetic patients, a Cox regression model was used. With death or re-infarction as endpoint, the following prognostic factors had an impact on event-free survival: age (P<0.001), HbA1c (P=0.002), cortisol (P<0.001) and thrombolytic treatment (P=0.001). There was a correlation between cortisol and blood glucose at admission (r=0.44, P<0.001). Fasting blood glucose day 5 showed no association with event-free survival.

CONCLUSIONS: In non-diabetic patients with AMI, admission HbA1c and cortisol were predictors for 5.5-year survival without recurrent non-fatal myocardial infarction. The glucometabolic status of importance for prognosis was detected by HbA1c but not by fasting blood glucose or admission blood glucose, of which the latter was influenced by cortisol.

Place, publisher, year, edition, pages
2003. Vol. 254, no 5, 494-503 p.
Keyword [en]
Aged, Blood Glucose/*metabolism, Diabetes Mellitus/blood, Disease-Free Survival, Female, Follow-Up Studies, Hemoglobin A; Glycosylated/*analysis, Humans, Hydrocortisone/blood, Male, Myocardial Infarction/*blood, Prognosis, Proportional Hazards Models, Prospective Studies, Research Support; Non-U.S. Gov't, Survival Analysis
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-90406DOI: 10.1046/j.1365-2796.2003.01221.xPubMedID: 14535972OAI: oai:DiVA.org:uu-90406DiVA: diva2:162749
Available from: 2003-05-02 Created: 2003-05-02 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Diabetes mellitus and related glucometabolic disturbances in acute myocardial infarction: Diagnosis, prevalence and prognostic implications
Open this publication in new window or tab >>Diabetes mellitus and related glucometabolic disturbances in acute myocardial infarction: Diagnosis, prevalence and prognostic implications
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In patients with diabetes mellitus (DM), acute myocardial infarction (AMI) is a major cause of death. We have studied two populations with respect to the relationship between DM or related glucometabolic disturbances and AMI.

In the first population, the prevalence of DM and the importance of the glycaemic state for the long-term prognosis in non-diabetic patients were investigated in patients with AMI admitted to the Coronary Care Unite at Västerås Central Hospital.

In the second population, the prevalence of impaired glucose tolerance (IGT), DM and other metabolic abnormalities was investigated in patients with AMI and without known DM admitted to the Coronary Care Units at Västerås and Karolinska Hospital, Stockholm.

21% of the patients with AMI had previously known DM and 4% had newly detected DM if diagnosis is based upon fasting blood glucose (F-BG). The glycemic state, measured as HbA1c, at a 5.5 years follow-up was a risk factor for re-infarction and/or death in non-diabetic patients after AMI.

If an oral glucose tolerance test (OGTT) is performed, 40-45% of all patients with AMI have DM and in addition about 30% have IGT. Both an OGTT and a single post-challenge blood glucose value after 60 minutes performed at hospital discharge, were independent predictors of IGT or DM at follow-up. Insulin resistance, measured by homeostatic model assessment (HOMA-IR), decreased during hospital stay, with no further decrease from hospital discharge to follow-up.

In summary, the studies in this dissertation have revealed an unexpectedly high prevalence of abnormal glucose tolerance in patients with AMI. The glycaemic state, reflected by HbA1c, in non-diabetic patients after AMI has an impact on the long-term prognosis. Consequently, in all patients with AMI, HbA1c and casual blood glucose should be measured at admission and, at least, F-BG at hospital discharge.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2003. 64 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1255
Keyword
Medicine, Diabetes mellitus, impaired glucose tolerance, insulin resistance, prevalence, diagnosis, oral glucose tolerance test, acute myocardial infarction, prognosis, Medicin
National Category
Dermatology and Venereal Diseases
Research subject
Medicine
Identifiers
urn:nbn:se:uu:diva-3423 (URN)91-554-5614-6 (ISBN)
Public defence
2003-05-24, Aulan, Gamla Vårdgymnasiet, ingång 21, Västerås, 13:15
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Supervisors
Available from: 2003-05-02 Created: 2003-05-02Bibliographically approved

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Nilsson, GöranBerne, ChristianLeppert, Jerzy

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