Importance of oral glucose testing in the diagnostic work-up of acute myocardial infarction
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Diabetes mellitus (DM) and impaired glucose tolerance (IGT) appear to be common in patients with contemporaneous myocardial infarction and no previous diagnosis of DM. These often undiagnosed comorbidities are associated with poorer cardiovascular prognosis. In order to assess the usefulness of oral glucose tolerance testing (OGTT) in this patient population, an OGTT with 75 g glucose was conducted in 61 non-diabetic patients admitted with AMI, prior to discharge. Newly diagnosed DM was detected in 31% and IGT in 33% of patients. Among patients with newly diagnosed DM, only 32% had fasting plasma glucose (FPG) >6.1 mmol/L. The 12-month major adverse cardiac event rate was 4.5% in subjects with normal glucose tolerance, 15% in those with IGT and 32% in patients with DM. In the authors’ view, the false reassurance of a normal FPG denies a significant proportion of undiagnosed diabetics the chance of appropriate treatment of hyperglycaemia and/or underlying metabolic abnormalities.
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