Glucose abnormalities in patients with myocardial infarction: prevalence, diagnosis, and prognostic implications - GAMI

Description:

The goal of the GAMI trial was to evaluate the frequency and association with outcomes of diabetes and impaired glucose, as assessed by use of an oral glucose tolerance test (OGTT) in patients presenting with acute myocardial infarction (MI).

Study Design

Study Design:

Patients Enrolled: 366
Mean Follow Up: One year for OGTT; 2.8 years for clinical events
Mean Patient Age: Mean age 64 years
Female: 32

Patient Populations:

Acute MI and admission glucose <11.1 mmol/l

Exclusions:

Known diabetes, age >80 years, or serum creatinine >200

Drug/Procedures Used:

Patients presenting with an acute MI underwent an OGTT at baseline, three months, and one year. Patients were matched for age and gender to healthy controls, who also underwent an OGTT.

Principal Findings:

Baseline OGTT met levels of diabetes in 33% of patients, was impaired in 34% of patients, and was normal in 33% of patients. At three months, 25% met the level for diabetes, 41% had impaired OGTT, and 34% had a normal OGTT and at one year, the numbers were 25%, 40%, and 35%, respectively. The overall abnormal rate (i.e., diabetes and impaired OGTT) was similar at baseline (67%), three months (66%), and one year (65%).

Compared to the three-month data in the acute MI patients, the control patients had a higher rate of normal OGTT (65% vs. 34%) and a lower rate of impaired OGTT (24% vs. 41%) and diabetes (11% vs. 25%).

In acute MI patients, the composite of death, reinfarction, stroke, and severe heart failure at 2.8 years was higher in patients with abnormal OGTT compared with normal OGTT (p=0.002). Abnormal OGTT remained a correlate of the composite event rate after adjustment in a multivariate model (hazard ratio 4.2, p=0.019). There were eight deaths in the study, all occurring in patients with an abnormal glucose level.

Interpretation:

Among patients with an acute MI, abnormal glucose levels can be detected early after an acute MI, and abnormal levels are more common in acute MI patients than among patients without an MI. Additionally, abnormal glucose level was a strong correlate of long-term cardiac events, including mortality.

While the trial provides novel data on the relation between abnormal glucose as detected by OGTT and cardiac events, the number of patients in the trial was small and there were few events. Larger trials will be need to confirm these findings.

References:

Ryden L. GAMI: Glucose abnormalities in patients with myocardial infarction—prevalence, diagnosis and prognostic implications. Paper presented at the European Society of Cardiology Congress 2004, 29 August-1 September, Munich, Germany.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Glucose Intolerance, Myocardial Infarction, Stroke, Glucose Tolerance Test, Heart Failure, Diabetes Mellitus


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