Impaired glucose tolerance or newly diagnosed diabetes mellitus diagnosed during admission adversely affects prognosis after myocardial infarction: An observational study

Objective To investigate the prognostic effect of newly diagnosed diabetes mellitus (NDM) and impaired glucose tolerance (IGT) post myocardial infarction (MI). Research Design and Methods Retrospective cohort study of 768 patients without preexisting diabetes mellitus post-MI at one centre in Yorkshire between November 2005 and October 2008. Patients were categorised as normal glucose tolerance (NGT n = 337), IGT (n = 279) and NDM (n = 152) on predischarge oral glucose tolerance test (OGTT). Primary end-point was the first occurrence of major adverse cardiovascular events (MACE) including cardiovascular death, non-fatal MI, severe heart failure (HF) or non-haemorrhagic stroke. Secondary end-points were all cause mortality and individual components of MACE. Results Prevalence of NGT, impaired fasting glucose (IFG), IGT and NDM changed from 90%, 6%, 0% and 4% on fasting plasma glucose (FPG) to 43%, 1%, 36% and 20% respectively after OGTT. 102 deaths from all causes (79 as first events of which 46 were cardiovascular), 95 non fatal MI, 18 HF and 9 non haemorrhagic strokes occurred during 47.2 ± 9.4 months follow up. Event free survival was lower in IGT and NDM groups. IGT (HR 1.54, 95% CI: 1.06–2.24, p = 0.024) and NDM (HR 2.15, 95% CI: 1.42–3.24, p = 0.003) independently predicted MACE free survival. IGT and NDM also independently predicted incidence of MACE. NDM but not IGT increased the risk of secondary end-points. Conclusion Presence of IGT and NDM in patients presenting post-MI, identified using OGTT, is associated with increased incidence of MACE and is associated with adverse outcomes despite adequate secondary prevention

Preoperative localisation for parathyroid surgery in primary hyperparathyroidism: a study to evaluate the clinical utility of different imaging modalities

Primary hyperparathyroidism (PHPT) is caused by a solitary benign adenoma in 80‐85% of cases, but may also be due to multi‐gland or ectopic disease, hyperplasia, and rarely parathyroid carcinoma. Preoperative localisation studies are important to identify patients suitable for minimally invasive parathyroid surgery. The aim of this study was to evaluate the accuracy of ultrasound (US), parathyroid scintigraphy (MIBI) and computed tomography (CT) utilised in the preoperative setting in a district general hospital, with limited access to single photon‐emission computed tomography (SPECT)

Kaplan–Meier estimates for the three groups showing survival free of all cause mortality.

<p>Numbers below graph are the number of patients at risk. Survival compared using log-rank test.</p

Clinical characteristics of the study population.

<p>Clinical characteristics of the study population.</p

Adjusted logistic regression for the primary and secondary end-points at the end of follow up according to glucometabolic state after the oral glucose tolerance test.

<p>* Odds ratio adjusted for age, gender, previous history of myocardial infarction, smoking status, hyperlipidaemia, hypertension, discharge diagnosis (STEMI, NSTEMI), discharge medications i.e. aspirin, clopidogrel, statin, ACEI or ARB and beta-blockers and revascularisation.</p><p>**Unadjusted Odds ratio.</p><p>Adjusted logistic regression for the primary and secondary end-points at the end of follow up according to glucometabolic state after the oral glucose tolerance test.</p

First cardiovascular events in relation to glucometabolic status.

<p>* Major adverse cardiovascular events: first occurrence of cardiovascular death, non- fatal re-infarction, non-haemorrhagic stroke or severe heart failure.</p><p>Events that occurred until death or Feb 1, 2011. Each event was recorded only once.</p