Open Access负荷后血糖峰值而不是空腹血糖决定未知或新发糖尿病患者心肌梗死后的预后
Author(s) -
Chattopadhyay Sudipta,
George Anish,
John Joseph,
Sathyapalan Thozhukat
Publication year - 2021
Publication title -
journal of diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.949
H-Index - 43
eISSN - 1753-0407
pISSN - 1753-0393
DOI - 10.1111/1753-0407.13111
Subject(s) - mace , medicine , hazard ratio , myocardial infarction , proportional hazards model , cohort , diabetes mellitus , cardiology , survival analysis , retrospective cohort study , gastroenterology , endocrinology , percutaneous coronary intervention , confidence interval
Background The effect of postload glucose spikes (PGS), the difference between 2 hour post‐load plasma glucose (2hPLPG) and fasting plasma glucose (FPG), on post–myocardial infarction (post‐MI) prognosis in nondiabetic patients is unexplored. Methods This is a retrospective cohort analysis of 847 nondiabetic post‐MI survivors who underwent a predischarge oral glucose tolerance test (median PGS: 2.4 mmol/L). Patients were divided into the unmatched groups 1 and 2 (PGS ≤ and > 2.4 mmol/L) and the propensity score‐matched groups 1M and 2M (355 pairs assembled from the overall cohort), and these groups were compared. Major adverse cardiac events (MACE: death and nonfatal reinfarction) were recorded during follow‐up (median: 3.4 years). Event‐free survival was compared by the Kaplan‐Meier method. Multivariate Cox proportional hazards regression determined the predictors of MACE. C‐statistics (change in area under the curve, δAUC), continuous net reclassification improvement (NRI >0 ), and integrated discrimination improvement (IDI) were used to compare models. Results The number of MACE was higher in groups 2 (27.3% vs 14.2%, P < .001) and 2M (24.5% vs 15.5%, P < .001). Event‐free survival was worse in groups 2 (hazard ratio [HR] 2.01; 95% CI, 1.49‐2.71; P < .001) and 2M (HR 1.63; 95% CI, 1.17‐2.27; P = .004). PGS independently predicted MACE‐free survival in the whole (HR 1.16; 95% CI, 1.06‐1.26; P = .002) and matched cohort (HR 1.12; 95% CI, 1.02‐1.24; P = .021). PGS, but not FPG or 2hPPG, improved the predictive performance of the base model (δAUC 0.013, P = .046), with greater improvement seen when PGS was added and compared to 2hPPG (δAUC 0.005, P = .034; NRI >0 0.2107, P = .013; IDI 0.0042, P = .046). Conclusion PGS is a better predictor of post‐MI prognosis than 2hPPG in nondiabetic patients.