Newly Discovered Abnormal Glucose Tolerance in Patients with Acute Myocardial Infarction and Cardiovascular Outcomes: A Meta-analysis

Background: The prevalence of unrecognized abnormal glucose tolerance (AGT) and the incidence of recurrent CV events in acute MI patients has not been systematically evaluated.

Purposes: (1) To define the prevalence of newly discovered AGT; (2) To examine the risk of recurrent MACE and mortality in acute MI patients.

Data sources: MEDLINE, Embase, Cochrane library, and Google Scholar

Study selection: Inclusion criteria: (1) prospective studies in acute MI patients without known history of diabetes; (2) AGT diagnosed using FPG, 2-hour OGTT or A1c; (3) incidence of MACE and/or all-cause mortality in newly discovered AGT were provided.

Data extraction: Two investigators extracted the data. Pooled prevalence, incidence rate ratios and hazard ratios (HR) were calculated using random-effect models.

Data synthesis: In 19 studies (n = 41,509; median follow up = 3.1 years), prevalence of newly discovered AGT = 48.4% (95%CI 40.2-56.6). Prediabetes had higher mortality risk than NGT (HR = 1.36, 95%CI 1.13-1.63, p<0.001) and MACE (HR = 1.42, 95%CI 1.20-1.68, p<0.001). Newly diagnosed diabetes had higher mortality risk than NGT (HR = 1.74, 95% CI 1.48 – 2.05, p<0.001) and MACE (HR = 1.54, 95% CI 1.23-1.93, p<0.001).

Limitations: This is not an individual patient data meta-analysis. Time to event analysis and covariate-adjusted analysis cannot be conducted to examine heterogeneity reliably. Few studies reported CV death and heart failure hospitalizations.

Conclusions: Acute MI patients have a high prevalence of newly discovered AGT. Aggressive risk reduction strategies in this population, especially in prediabetes, are warranted.