On the prognostic value of post-load glucose in patients with coronary artery disease
Abstract
This editorial refers to ‘Adjustment of the GRACE score by 2-hour post-load glucose improves prediction of long-termmajor adverse cardiac events in acute coronary syndrome in patients without known diabetes’†, by S. Chattopadhyay et al., on page 2740. In this issue of the European Heart Journal, Chattopadhyay et al.1 demonstrate the importance of 2 h post-load glucose (2hPG), derived form an oral glucose tolerance test (OGTT) when added as a continuous variable to the Global Registry of Acute Coronary Events (GRACE) score, in improving the prediction of death and recurrent non-fatal myocardial infarction in survivors of an acute coronary syndrome without known diabetes mellitus (DM). In contrast, fasting plasma glucose (FPG) did not increase the predictability of prognostic models containing the GRACE score. This score, based on a multitude of variables (e.g. age, gender, heart rate, systolic blood pressure, creatinine, congestive heart failure, history of myocardial infarction, ST-segment depression, elevated troponin, and in-hospital revascularization), is well established in helping guide clinicians regarding the type and intensity of therapy;2 but, as the authors rightly note, thus far does not contain glycaemic measures and accordingly it is unknown whether doing this could improve risk predictability. A first indication that 2hPG is a prognostic indicator for future cardiovascular events in patients with acute coronary events came from the Glucose in Acute Myocardial…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 4,422 participants or records.
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