Aims: To study: (1) the prevalence of newly discovered AGT in subjects presented with AMI and (2) the risk of recurrent major adverse cardiovascular events (MACE and mortality) in this population.
Methods: Electronic databases were searched. Studies were included for analysis if: (1) they were prospective or retrospective studies in AMI subjects without known history of diabetes; (2) diagnosis of AGT was made with FPG, 2-hour PG (OGTT) or A1c, (3) provided incidence of MACE and/or all-cause mortality in newly discovered AGT subjects compared with NGT subjects. AGT was further divided into prediabetes and diabetes. Pooled prevalence and hazard ratios (HR) were calculated using random-effect model.
Results: Total of41,677 subjects from 20 studies were included in the analysis. Median follow-up time was 3.7 ±2.8 years. The pooled prevalence of newly discovered AGT in AMI subjects was 49.3%. Compared to NGT, subjects with AGT had higher risk of mortality (HR = 1.66, 95% CI 1.34-2.05, p<0.001) and MACE (HR = 1.80, 95% CI 1.40-2.31, p<0.001). Compared to NGT, prediabetes group had higher risk for mortality (HR = 1.82, 95% CI 1.30-2.54, p<0.001) and MACE (HR = 1.67, 95% CI 1.24-2.26, p<0.001). Of note, prediabetes subjects had a higher risk of MACE compared to subjects with newly diagnosed diabetes (HR = 1.76, 95% CI 1.35-2.29, p<0.001), whereas there was no difference in all-cause mortality between prediabetes and diabetes subjects (HR = 0.97 95% CI 0.60-1.55, p=NS).
Conclusion: This meta-analysis showed a high prevalence of newly discovered AGT in patients with AMI. The increased risk in MACE and mortality was observed before the onset of diabetes, i.e., in prediabetes. The discovery of AGT in patients who present with an AMI is a strong predictor for mortality and MACE. Since prediabetes and diabetes subjects are at the same high CV risk, factors other than hyperglycemia must explain the markedly increased incidence of MACE and all-cause mortality.
N. Laichuthai: None. R.A. DeFronzo: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Elcelyx Therapeutics, Inc., Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc. Speaker's Bureau; Self; AstraZeneca, Novo Nordisk Inc.