Suzanne V Arnold1, Kasia J Lipska2, Yan Li3, Darren K McGuire4, Abhinav Goyal5, John A Spertus6, Mikhail Kosiborod6. 1. Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO. Electronic address: suz.v.arnold@gmail.com. 2. Yale University School of Medicine, New Haven, CT. 3. Saint Luke's Mid America Heart Institute, Kansas City, MO. 4. University of Texas Southwestern Medical Center, Dallas, TX. 5. Emory School of Medicine, Atlanta, GA. 6. Saint Luke's Mid America Heart Institute, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
Abstract
BACKGROUND: Patients with an acute myocardial infarction (AMI) who have glucose abnormalities are at increased risk for death and adverse ischemic outcomes. The contemporary prevalence of glucose abnormalities among AMI patients in the United States, as determined by hemoglobin A1c (HbA1c), is unknown. METHODS: Patients hospitalized with AMI in a 24-site US AMI registry from 2005 to 2008 were examined for the presence of dysglycemia using HbA1c, which was analyzed at a core laboratory. Patients were categorized by American Diabetes Association guidelines as having diabetes (HbA1c ≥ 6.5%), prediabetes (HbA1c 5.7%-6.4%), or normoglycemia. Baseline demographic, clinical, and metabolic characteristics, as well as long-term all-cause mortality, were compared among groups. RESULTS: Among 2,853 patients with AMI, 1,083 (38%) had diabetes, of which 196 (18%) were newly diagnosed. There were an additional 887 patients (31%) with prediabetes and 883 patients (31%) who had normal glucose metabolism. Patients with metabolic abnormalities were older, were more frequently female, and had higher prevalence of cardiac and noncardiac comorbidities, including multivessel disease and left ventricular systolic dysfunction. Patients with increasing metabolic abnormalities had higher mortality over the 3 years after the AMI (8.6% in those with normoglycemia, 10.6% in prediabetes, 11.3% in newly diagnosed diabetes, and 20.3% in known diabetes; log rank P < .001). CONCLUSIONS: In a large US AMI registry, we found that nearly 7 in 10 patients had dysglycemia, with 38% having diabetes and an additional 31% with prediabetes based on HbA1c levels. Over half of the patients who did not have a known diagnosis of diabetes at the time of admission had either newly diagnosed diabetes or prediabetes. Progressively greater severity of dysglycemia was also associated with incremental increase in long-term mortality. These data highlight the AMI hospitalization as a key opportunity to screen for glucose abnormalities so that appropriate interventions and patient education efforts can be implemented prior to discharge.
BACKGROUND:Patients with an acute myocardial infarction (AMI) who have glucose abnormalities are at increased risk for death and adverse ischemic outcomes. The contemporary prevalence of glucose abnormalities among AMI patients in the United States, as determined by hemoglobin A1c (HbA1c), is unknown. METHODS:Patients hospitalized with AMI in a 24-site US AMI registry from 2005 to 2008 were examined for the presence of dysglycemia using HbA1c, which was analyzed at a core laboratory. Patients were categorized by American Diabetes Association guidelines as having diabetes (HbA1c ≥ 6.5%), prediabetes (HbA1c 5.7%-6.4%), or normoglycemia. Baseline demographic, clinical, and metabolic characteristics, as well as long-term all-cause mortality, were compared among groups. RESULTS: Among 2,853 patients with AMI, 1,083 (38%) had diabetes, of which 196 (18%) were newly diagnosed. There were an additional 887 patients (31%) with prediabetes and 883 patients (31%) who had normal glucose metabolism. Patients with metabolic abnormalities were older, were more frequently female, and had higher prevalence of cardiac and noncardiac comorbidities, including multivessel disease and left ventricular systolic dysfunction. Patients with increasing metabolic abnormalities had higher mortality over the 3 years after the AMI (8.6% in those with normoglycemia, 10.6% in prediabetes, 11.3% in newly diagnosed diabetes, and 20.3% in known diabetes; log rank P < .001). CONCLUSIONS: In a large US AMI registry, we found that nearly 7 in 10 patients had dysglycemia, with 38% having diabetes and an additional 31% with prediabetes based on HbA1c levels. Over half of the patients who did not have a known diagnosis of diabetes at the time of admission had either newly diagnosed diabetes or prediabetes. Progressively greater severity of dysglycemia was also associated with incremental increase in long-term mortality. These data highlight the AMI hospitalization as a key opportunity to screen for glucose abnormalities so that appropriate interventions and patient education efforts can be implemented prior to discharge.
Authors: Lars Rydén; Peter J Grant; Stefan D Anker; Christian Berne; Francesco Cosentino; Nicolas Danchin; Christi Deaton; Javier Escaned; Hans-Peter Hammes; Heikki Huikuri; Michel Marre; Nikolaus Marx; Linda Mellbin; Jan Ostergren; Carlo Patrono; Petar Seferovic; Miguel Sousa Uva; Marja-Riita Taskinen; Michal Tendera; Jaakko Tuomilehto; Paul Valensi; Jose Luis Zamorano; Jose Luis Zamorano; Stephan Achenbach; Helmut Baumgartner; Jeroen J Bax; Héctor Bueno; Veronica Dean; Christi Deaton; Cetin Erol; Robert Fagard; Roberto Ferrari; David Hasdai; Arno W Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Patrizio Lancellotti; Ales Linhart; Petros Nihoyannopoulos; Massimo F Piepoli; Piotr Ponikowski; Per Anton Sirnes; Juan Luis Tamargo; Michal Tendera; Adam Torbicki; William Wijns; Stephan Windecker; Guy De Backer; Per Anton Sirnes; Eduardo Alegria Ezquerra; Angelo Avogaro; Lina Badimon; Elena Baranova; Helmut Baumgartner; John Betteridge; Antonio Ceriello; Robert Fagard; Christian Funck-Brentano; Dietrich C Gulba; David Hasdai; Arno W Hoes; John K Kjekshus; Juhani Knuuti; Philippe Kolh; Eli Lev; Christian Mueller; Ludwig Neyses; Peter M Nilsson; Joep Perk; Piotr Ponikowski; Zeljko Reiner; Naveed Sattar; Volker Schächinger; André Scheen; Henrik Schirmer; Anna Strömberg; Svetlana Sudzhaeva; Juan Luis Tamargo; Margus Viigimaa; Charalambos Vlachopoulos; Robert G Xuereb Journal: Eur Heart J Date: 2013-08-30 Impact factor: 29.983
Authors: Suzanne V Arnold; Paul S Chan; Philip G Jones; Carole Decker; Donna M Buchanan; Harlan M Krumholz; P Michael Ho; John A Spertus Journal: Circ Cardiovasc Qual Outcomes Date: 2011-07
Authors: Harlan M Krumholz; Yun Wang; Jersey Chen; Elizabeth E Drye; John A Spertus; Joseph S Ross; Jeptha P Curtis; Brahmajee K Nallamothu; Judith H Lichtman; Edward P Havranek; Frederick A Masoudi; Martha J Radford; Lein F Han; Michael T Rapp; Barry M Straube; Sharon-Lise T Normand Journal: JAMA Date: 2009-08-19 Impact factor: 56.272
Authors: Suzanne V Arnold; Kasia J Lipska; Yan Li; Abhinav Goyal; Thomas M Maddox; Darren K McGuire; John A Spertus; Mikhail Kosiborod Journal: J Am Coll Cardiol Date: 2013-04-03 Impact factor: 24.094
Authors: Sean M Donahoe; Garrick C Stewart; Carolyn H McCabe; Satishkumar Mohanavelu; Sabina A Murphy; Christopher P Cannon; Elliott M Antman Journal: JAMA Date: 2007-08-15 Impact factor: 56.272
Authors: Eva C Knudsen; Ingebjørg Seljeflot; Michael Abdelnoor; Jan Eritsland; Arild Mangschau; Harald Arnesen; Geir O Andersen Journal: Cardiovasc Diabetol Date: 2009-01-30 Impact factor: 9.951
Authors: Suzanne V Arnold; Joshua M Stolker; Kasia J Lipska; Philip G Jones; John A Spertus; Darren K McGuire; Silvio E Inzucchi; Abhinav Goyal; Thomas M Maddox; Marcus Lind; Divya Gumber; Supriya Shore; Mikhail Kosiborod Journal: Circ Cardiovasc Qual Outcomes Date: 2015-04-21
Authors: Andrew P DeFilippis; Andrew R Chapman; Nicholas L Mills; James A de Lemos; Armin Arbab-Zadeh; L Kristin Newby; David A Morrow Journal: Circulation Date: 2019-08-16 Impact factor: 29.690
Authors: Yu Ri Kim; Myung Ho Jeong; Youngkeun Ahn; Ju Han Kim; Young Joon Hong; Min Chul Kim; Kyung Hoon Cho; Xiong Yi Han Journal: Korean J Intern Med Date: 2021-01-12 Impact factor: 2.884