Glucose metabolism in acute myocardial infarction

Background: A high prevalence of newly detected impaired glucose tolerance (IGT) and diabetes mellitus (DM) with acute myocardial infarction (AMI) has been reported. Therefore, the study was conducted to evaluate the frequency of post challenge (OGTT) hyperglycemia in the patients admitted with AMI. Material and Methods: This was a hospital based prospective study conducted from June 2007 to May 2008 at the Coronary Care Unit, Cardiology division, Rashid Hospital Dubai, UAE.). The only patients who suffered from acute myocardial infarction (both ST segment elevation and Non ST segment elevation) were recruited in the study, whereas patients with history of diabetes mellitus, chronic renal failure and ischemic heart disease were excluded from the study. An oral glucose tolerance test (OGTT) with 75 gm of glucose was performed at the time of discharge. After overnight fasting, blood samples were collected to determine the plasma glucose at 0 and 120 minutes after the load. Other laboratory investigations included lipid profile (total cholesterol, triglycerides, HDL and LDL), fasting plasma glucose and HbA1C at the time of admission. All patients under the study were also subjected to coronary angiogram. Results: A total of 75 patients fulfilled the inclusion criteria for the study, 54.6% had ST segment elevation, whereas 45.4% suffered from Non ST segment elevation acute myocardial infarction. On OGTT, 72% patients were found to have disturbed glucose metabolism, Impaired Glucose Tolerance in 40% and Diabetes Mellitus in 32%. A significant coronary arteries atherosclerosis was found in 76.1%, 96.8% and 95.8% in patients with normal glucose tolerance, impaired glucose tolerance and diabetes mellitus, respectively. No significant difference for age, lipid profile and family history of diabetes was found among the normal and the patients with disturbed glucose metabolism; however BMI was slight higher in diabetic patients than the patients with IGT and normal glucose. Conclusion: Abnormal glucose metabolism (IGT and DM) is common after acute myocardial infarction (AMI). To find out the prevalence of disturbed glucose metabolism and prevent future adverse cardiovascular events, all non diabetic patients admitted with AMI should undergo OGTT at the time of discharge.