Major adverse cardiovascular events in patients after acute myocardial infarction treated invasively and different patterns of glucometabolic disturbances evaluated at mid-term follow-up

Paweł Francuz, Tomasz Podolecki, Monika Kozieł, Zbigniew Kalarus, Jacek Kowalczyk


Objective:  To assess the impact of glucometabolic status (GS) evaluated at hospital discharge and at mid-term follow-up visit (FU-visit) on major adverse cardiovascular events (MACE) in patients (pts) with acute myocardial infarction (AMI) treated invasively.

Material and Methods: Study encompassed 368 AMI-pts treated invasively, in whom GS was assessed by 2-hour post load glycemia at hospital discharge and at FU-visit after 6 months. Patients were divided into two groups with respect to GS at hospital discharge: abnormal glucose tolerance (AGT, n=149), normal glucose tolerance (NGT, n=219). Each of those groups was divided into two subgroups with respect to GS at FU-visit: persistent AGT (pAGT, n=101), transient AGT (tAGT, n=48), newly detected AGT (newAGT, n=114), persistent NGT (pNGT, n=105). Median follow-up duration after FU-visit was 24.5 months.

Results: There was a trend towards more subjects with MACE in AGT than NGT group (24.2% vs. 16%; p=0.051). More AGT-pts were hospitalized due to decompensated heart failure (6% vs. 0.5%; p=0.002). However, there were no significant differences in MACE between subjects with pAGT and tAGT, including heart failure hospitalizations. Among NGT-pts there were no significant differences in particular MACE between newAGT-pts and pNGT-pts.

Conclusions: In AMI-pts treated invasively, who had abnormal glucose tolerance at hospital discharge, the improvement in glucometabolic status after 6 months was not related to lower risk of hospitalization due to decompensated heart failure.


abnormal glucose tolerance; coronary artery disease; mortality; oral glucose tolerance test; heart failure hospitalization

Full Text:



Bartnik M, Malmberg K, Norhammar A, Tenerz A, Ohrvik J, Rydén L. Newly detected abnormal glucose tolerance: an important predictor of long‑term outcome after myocardial infarction. Eur Heart J. 2004;25(22):1990–1997.

Tamita K, Katayama M, Takagi T, Yamamuro A, Kaji S, Yoshikawa J, et al. Newly diagnosed glucose intolerance and prognosis after acute myocardial infarction: comparison of post‑challenge versus fasting glucose concentrations. Heart. 2012;98(11):848–854.

Kuramitsu S, Yokoi H, Domei T, Nomura A, Watanabe H, Yamaji K, et al. Impact of post challenge hyperglycemia on clinical outcomes in Japanese patients with stable angina undergoing percutaneous coronary intervention. Cardiovasc Diabetol. 2013;12:74.

Kitada S, Otsuka Y, Kokubu N, Kasahara Y, Kataoka Y, Noguchi T, et al. Post‑load hyperglycemia as an important predictor of long‑term adverse cardiac events after acute myocardial infarction: a scientific study. Cardiovasc Diabetol. 2010;9:75.

Mazurek M, Kowalczyk J, Lenarczyk R, Zielinska T, Sedkowska A, Pruszkowska‑Skrzep P, et al. The prognostic value of different glucose abnormalities in patients with acute myocardial infarction treated invasively. Cardiovasc Diabetol. 2012;11:78.

Henareh L, Agewall S. 2-h postchallenge plasma glucose predicts cardiovascular events in patients with myocardial infarction without known diabetes mellitus. Cardiovasc Diabetol. 2012;11:93.

Francuz P, Podolecki T, Przybylska‑Siedlecka K, Kalarus Z, Kowalczyk J. Long‑term prognosis is related to mid‑term changes of glucometabolic status in patients with acute myocardial infarction treated invasively. Kardiol. Pol. 2016. doi: 10.5603/KP.a2016.0128.

Kowalczyk J, Mazurek M, Zielinska T, Lenarczyk R, Sedkowska A, Swiatkowski A, et al. Prognostic significance of HbA1c in patients with AMI treated invasively and newly detected glucose abnormalities. Eur J Prev Cardiol. 2015;22(6):798–806.

Bronisz A, Kozinski M, Magielski P, Fabiszak T, Gierach J, Swiatkiewicz I, et al. Value of oral glucose tolerance test in the acute phase of myocardial infarction. Cardiovasc Diabetol. 2011;10:21.

Knudsen EC, Seljeflot I, Abdelnoor M, Eritsland J, Mangschau A, Müller C, et al. Impact of newly diagnosed abnormal glucose regulation on long‑term prognosis in low risk patients with ST‑elevation myocardial infarction: A follow‑up study. BMC Endocr Disord. 2011;11:14.

Srinivas‑Shankar U, Somauroo JD, Delduca AM, Jordan TS, Bowles SA, Rutter MK. Temporal change in glucose tolerance in non‑ST‑elevation myocardial infarction. Diabetes Res Clin Pract. 2008;82(3):310–316.

Tenerz A, Norhammar A, Silveira A, Hamsten A, Nilsson G, Rydén L, Malmberg K. Diabetes, insulin resistance, and the metabolic syndrome in patients with acute myocardial infarction without previously known diabetes. Diabetes Care. 2003;26(10):2770–2776.

Marfella R, Siniscalchi M, Esposito K, Sellitto A, De Fanis U, Romano C, et al. Effects of stress hyperglycemia on acute myocardial infarction: role of inflammatory immune process in functional cardiac outcome. Diabetes Care. 2003;26(11):3129–3135.

Maisch B, Alter P, Pankuweit S. Diabetic cardiomyopathy--fact or fiction? Herz. 2011;36(2):102–115.

Henareh L, Lind B, Brodin LA, Agewall S. Disturbed glucose metabolism is associated with left ventricular dysfunction using tissue Doppler imaging in patients with myocardial infarction. Clin Physiol Funct Imaging. 2007;27(1):60–66.

Ansley DM, Wang B. Oxidative stress and myocardial injury in the diabetic heart. J Pathol. 2013;229(2):232–241.

Picchi A, Capobianco S, Qiu T, Focardi M, Zou X, Cao JM, et al. Coronary microvascular dysfunction in diabetes mellitus: A review. World J Cardiol. 2010;2(11):377–390.

Steven S, Hollingsworth KG, Al‑Mrabeh A, Avery L, Aribisala B, Caslake M, et al. Very Low‑Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders. Diabetes Care. 2016;39(5):808–815.

Wascher TC, Schmoelzer I, Wiegratz A, Stuehlinger M, Mueller‑Wieland D, Kotzka J, et al. Reduction of postchallenge hyperglycaemia prevents acute endothelial dysfunction in subjects with impaired glucose tolerance. Eur J Clin Invest. 2005;35(9):551–557.

Kawano H, Motoyama T, Hirashima O, Hirai N, Miyao Y, Sakamoto T, Kugiyama K, Ogawa H, Yasue H. Hyperglycemia rapidly suppresses flow‑mediated endothelium‑dependent vasodilation of brachial artery. J Am Coll Cardiol. 1999;34(1):146–154.

Kato T, Inoue T, Node K. Postprandial endothelial dysfunction in subjects with new‑onset type 2 diabetes: an acarbose and nateglinide comparative study. Cardiovasc Diabetol. 2010;9:12.

Yun P, Du AM, Chen XJ, Liu JC, Xiao H. Effect of Acarbose on Long‑Term Prognosis in Acute Coronary Syndromes Patients with Newly Diagnosed Impaired Glucose Tolerance. J Diabetes Res. 2016;2016:1602083.

Sawada T, Tsubata H, Hashimoto N, Takabe M, Miyata T, Aoki K, et al. Effects of 6-month eicosapentaenoic acid treatment on postprandial hyperglycemia, hyperlipidemia, insulin secretion ability, and concomitant endothelial dysfunction among newly‑diagnosed impaired glucose metabolism patients with coronary artery disease. An open label, single blinded, prospective randomized controlled trial. Cardiovasc Diabetol. 2016;15(1):121.

Jokura H, Watanabe I, Umeda M, Hase T, Shimotoyodome A. Coffee polyphenol consumption improves postprandial hyperglycemia associated with impaired vascular endothelial function in healthy male adults. Nutr Res. 2015;35(10):873–881.



Copyright (c) 2017 Journal of Medical Science

Copyright 2018 by Journal of Medical Sciences