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Relationship of dysglycemia to acute myocardial infarct size and cardiovascular outcome as determined by cardiovascular magnetic resonance.

Mather AN, Crean A, Abidin N, Worthy G, Ball SG, Plein S, Greenwood JP - J Cardiovasc Magn Reson (2010)

Bottom Line: Clinical outcome data were collected at 18 months median follow-up.Patients with dysglycemia and DM also had lower event-free survival at 18 months (p = 0.005).This may, in part, account for their adverse prognosis following AMI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Cardiovascular and Neuronal Remodelling, University of Leeds, Leeds, UK.

ABSTRACT

Background: Improved outcomes for normoglycemic patients suffering acute myocardial infarction (AMI) over the last decade have not been matched by similar improvements in mortality for diabetic patients despite similar levels of baseline risk and appropriate medical therapy. Two of the major determinants of poor outcome following AMI are infarct size and left ventricular (LV) dysfunction.

Methods: Ninety-three patients with first AMI were studied. 22 patients had diabetes mellitus (DM) based on prior history or admission blood glucose ≥ 11.1 mmol/l. 13 patients had dysglycemia (admission blood glucose ≥ 7.8 mmol/l but < 11.1 mmol/l) and 58 patients had normoglycemia (admission blood glucose < 7.8 mmol/l). Patients underwent cardiac magnetic resonance (CMR) imaging at index presentation and median follow-up of 11 months. Cine imaging assessed LV function and late gadolinium contrast-enhanced imaging was used to quantify infarct size. Clinical outcome data were collected at 18 months median follow-up.

Results: Patients with dysglycemia and DM had larger infarct sizes by CMR than normoglycemic patients; at baseline percentage LV scar (mean (SD)) was 23.0% (10.9), 25.6% (12.9) and 15.8% (10.3) respectively (p = 0.001), and at 11 months percentage LV scar was 17.6% (8.9), 19.1% (9.6) and 12.4% (7.8) (p = 0.017). Patients with dysglycemia and DM also had lower event-free survival at 18 months (p = 0.005).

Conclusions: Patients with dysglycemia or diabetes mellitus sustain larger infarct sizes than normoglycemic patients, as determined by CMR. This may, in part, account for their adverse prognosis following AMI.

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Kaplan-Meier curves demonstrating event-free survival for all patients subdivided by glycemic status.
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Figure 5: Kaplan-Meier curves demonstrating event-free survival for all patients subdivided by glycemic status.

Mentions: Of the 58 patients with normoglycemia, 15 (25.9%) suffered at least one MACE, compared to 8 of the 13 patients (61.5%) with dysglycemia and 8 of the 22 patients (36.4%) in the DM group. From the entire cohort there were 3 deaths, 6 recurrent MIs, 11 revascularizations (9 PCI and 2 CABG), and 11 readmissions to hospital for a cardiovascular cause. There was a significant difference in overall event-free survival among the three groups of patients (log-rank test, p = 0.005) (Figure 5). Patients with dysglycemia were significantly more likely to experience an event at any time than normoglycemic patients, Hazard Ratio (HR) 3.82 (95% CI: 1.61, 9.06), but there was no significant difference in survival between patients with DM and normoglycemia, HR 1.48 (95% CI: 0.63, 3.50). When all patients with DM and peri-infarct dysglycemia were combined and compared to the normoglycemia group, as before 15/58 (25.9%) of those with normoglycemia suffered at least one MACE compared to 16/35 (45.7%) of those with DM and peri-infarct dysglycemia (χ2 = 3.87; p < 0.05).


Relationship of dysglycemia to acute myocardial infarct size and cardiovascular outcome as determined by cardiovascular magnetic resonance.

Mather AN, Crean A, Abidin N, Worthy G, Ball SG, Plein S, Greenwood JP - J Cardiovasc Magn Reson (2010)

Kaplan-Meier curves demonstrating event-free survival for all patients subdivided by glycemic status.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2984576&req=5

Figure 5: Kaplan-Meier curves demonstrating event-free survival for all patients subdivided by glycemic status.
Mentions: Of the 58 patients with normoglycemia, 15 (25.9%) suffered at least one MACE, compared to 8 of the 13 patients (61.5%) with dysglycemia and 8 of the 22 patients (36.4%) in the DM group. From the entire cohort there were 3 deaths, 6 recurrent MIs, 11 revascularizations (9 PCI and 2 CABG), and 11 readmissions to hospital for a cardiovascular cause. There was a significant difference in overall event-free survival among the three groups of patients (log-rank test, p = 0.005) (Figure 5). Patients with dysglycemia were significantly more likely to experience an event at any time than normoglycemic patients, Hazard Ratio (HR) 3.82 (95% CI: 1.61, 9.06), but there was no significant difference in survival between patients with DM and normoglycemia, HR 1.48 (95% CI: 0.63, 3.50). When all patients with DM and peri-infarct dysglycemia were combined and compared to the normoglycemia group, as before 15/58 (25.9%) of those with normoglycemia suffered at least one MACE compared to 16/35 (45.7%) of those with DM and peri-infarct dysglycemia (χ2 = 3.87; p < 0.05).

Bottom Line: Clinical outcome data were collected at 18 months median follow-up.Patients with dysglycemia and DM also had lower event-free survival at 18 months (p = 0.005).This may, in part, account for their adverse prognosis following AMI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Cardiovascular and Neuronal Remodelling, University of Leeds, Leeds, UK.

ABSTRACT

Background: Improved outcomes for normoglycemic patients suffering acute myocardial infarction (AMI) over the last decade have not been matched by similar improvements in mortality for diabetic patients despite similar levels of baseline risk and appropriate medical therapy. Two of the major determinants of poor outcome following AMI are infarct size and left ventricular (LV) dysfunction.

Methods: Ninety-three patients with first AMI were studied. 22 patients had diabetes mellitus (DM) based on prior history or admission blood glucose ≥ 11.1 mmol/l. 13 patients had dysglycemia (admission blood glucose ≥ 7.8 mmol/l but < 11.1 mmol/l) and 58 patients had normoglycemia (admission blood glucose < 7.8 mmol/l). Patients underwent cardiac magnetic resonance (CMR) imaging at index presentation and median follow-up of 11 months. Cine imaging assessed LV function and late gadolinium contrast-enhanced imaging was used to quantify infarct size. Clinical outcome data were collected at 18 months median follow-up.

Results: Patients with dysglycemia and DM had larger infarct sizes by CMR than normoglycemic patients; at baseline percentage LV scar (mean (SD)) was 23.0% (10.9), 25.6% (12.9) and 15.8% (10.3) respectively (p = 0.001), and at 11 months percentage LV scar was 17.6% (8.9), 19.1% (9.6) and 12.4% (7.8) (p = 0.017). Patients with dysglycemia and DM also had lower event-free survival at 18 months (p = 0.005).

Conclusions: Patients with dysglycemia or diabetes mellitus sustain larger infarct sizes than normoglycemic patients, as determined by CMR. This may, in part, account for their adverse prognosis following AMI.

Show MeSH
Related in: MedlinePlus