Inflammation, insulin resistance, and glucose intolerance in acute myocardial infarction patients without a previous diagnosis of diabetes mellitus

We examined the prevalence of impaired glucose metabolism and its association with inflammation and insulin resistance (IR) in acute myocardial infarction (AMI) patients without a previous diagnosis of diabetes. This prospective study enrolled 52 AMI patients, and 75-g oral glucose tolerance testing was performed on 30 patients at discharge and again 3 months later. We also measured serum adiponectin, high sensitive C-reactive protein, and IL-6 on both occasions. Data were compared with those of 30 type 2 diabetic patients without a history of AMI. Forty percent and 36.7% of AMI patients had impaired glucose tolerance (IGT) at discharge and at 3 months, respectively. The corresponding proportions for newly diagnosed diabetes are 33.0% and 30.0%. At discharge, AMI patients with IGT or diabetes showed higher high sensitive C-reactive protein and IL-6 levels compared with AMI patients with normal glucose tolerance or control type 2 diabetic patients. Furthermore, AMI patients with IGT or diabetes exhibited higher IR and lower serum adiponectin levels than AMI patients with normal glucose tolerance at 3 months after discharge. Previously undiagnosed diabetes and IGT are common in Korean patients with AMI. These glycometabolic abnormalities are associated with inflammation, IR, and serum adiponectin levels.     

新诊断的糖代谢异常对急性心肌梗死后左心室射血分数的影响

目的观察新诊断的糖代谢异常对急性心肌梗死后LVEF的影响。方法入选首次急性心肌梗死患者161例(对无糖尿病病史的患者发病7天后行口服葡萄糖耐量试验),根据检查结果及是否有糖尿病病史,分为正常糖耐量组(37例)、糖调节异常组(46例)、新诊断糖尿病组(37例)和既往已确诊糖尿病组(41例)。4组患者分别于发病后72 h内、30天行三维超声心动图检查评价左心室功能。结果糖调节异常组、新诊断糖尿病组和既往已确诊糖尿病组72 h内及30天随访时的LVEF均明显低于正常糖耐量组(72 h:(45.1±7.1)%、(45.0±7.2)%、(45.1±7.2)%vs(48.9±6.8)%,P<0.05;30天:(47.0±7.5)%、(47.8±7.3)%、(48.0±7.4)%vs (53.4±6.4)%,P<0.05]。结论新诊断的糖代谢异常也对急性心肌梗死后左心室功能产生不利的影响。     

溶栓治疗对急性心肌梗死患者胰岛素敏感性的影响

探讨溶栓治疗对急性心肌梗死 （AMI）患者空腹胰岛素及胰岛素抵抗的影响。检测 2 0例溶栓治疗和 2 2例未溶栓治疗的非糖尿病 AMI患者的空腹血糖 ,空腹胰岛素及胰岛素敏感性指数 ,并与 2 0例正常人作比较 ,AMI患者 4周后复查。结果 :AMI两组在急性期存在高胰岛素血症和胰岛素抵抗 ,4周后复查血胰岛素水平 ,胰岛素敏感性指数较急性期有明显下降 （P<0 .0 1） ,AMI溶栓治疗组的空腹胰岛素和胰岛素敏感性指数较未溶栓治疗组显著下降 （P<0 .0 5 ）。结论 :AMI存在高胰岛素血症及胰岛素抵抗 ,以急性期最明显 ,早期溶栓治疗能促进空腹胰岛素及胰岛素敏感性指数的下降     

非糖尿病患者急性心肌梗死早期胰岛素抵抗现象研究

目的:探讨既往无糖尿病病史的急性心肌梗死患者早期胰岛素抵抗情况.方法:2009-02至2009-09,在我院连续入选158例既往无糖尿病病史,且在发病24 h内接受急诊经皮冠状动脉介入治疗的ST段抬高急性心肌梗死患者,出院前均进行口服葡萄糖耐量试验,按照结果分为糖代谢正常组(n=44)、糖调节受损组(n=65)和新诊断糖尿病组(n=49),以稳态模型胰岛素抵抗指数(HOMA-IR)≥2.5认为存在胰岛素抵抗,评价不同糖代谢组患者急性期(入院时)与稳定期(出院时)的胰岛素抵抗情况.结果:158例患者中,胰岛素抵抗者急性期为50.0%(79/158例),稳定期为31.6%(50/158例),胰岛素抵抗比例在急性期明显多于稳定期(P=0.000),差异有统计学意义.急性期HOMA-IR(0.98±0.81)明显高于稳定期HOMA-IR(0.58±0.67),P<0.05,差异有统计学意义.急性期HOMA-IR,新诊断糖尿病组高于糖调节受损组和糖代谢正常组[(1.30±0.84)vs(0.96±0.78)vs(0.57±0.55),P均<0.05],差异均有统计学意义.稳定期HOMA-IR新诊断糖尿病组和糖调节受损组高于糖代谢正常组[(0.78±0.57)vs(0.57±0.80)vs(0.41±0.51),P均<0.05],差异有统计学意义.多元逐步回归方程显示,第2天空腹血糖[标准化回归系数(β)=0.230,P=0.000]、空腹胰岛素(β=0.758,P=0.000)、体重指数(β=0.087,P=0.005)和糖化血红蛋白(β=0.104,P=0.003)是急性期胰岛素抵抗的影响因素;体重指数(β=0.382,P=0.000)是稳定期胰岛素抵抗的影响因素.结论:无论糖代谢情况如何,胰岛素抵抗在急性心肌梗死早期有加重现象;第2天空腹血糖、糖化血红蛋白和体重指数是急性期胰岛素抵抗的影响因素,体重指数是稳定期胰岛素抵抗的影响因素.     

Effect of insulin infusion on electrocardiographic findings following acute myocardial infarction: importance of glycaemic control

Aims To determine the effects of insulin infusion and blood glucose levels during acute myocardial infarction (AMI) on electrocardiographic (ECG) features of myocardial electrical activity. Methods ECGs at admission and 24 h were examined in a randomized study of insulin infusion vs. routine care for AMI patients with diabetes or hyperglycaemia. Results were analysed according to treatment allocation and also according to average blood glucose level. Results ECG characteristics were similar at admission in both groups. Patients allocated to conventional treatment had prolongation of the QT interval (QTc) after 24 h but those receiving infused insulin did not. In patients with a mean blood glucose in the first 24 h > 8.0 mmol/l, new ECG conduction abnormalities were significantly more common than in patients with mean blood glucose ≤ 8.0 mmol/l (15.0% vs. 6.0%, P < 0.05). Conclusions Prevention of QTc prolongation by administration of insulin may reflect a protective effect on metabolic and electrical activity in threatened myocardial tissue. Abnormalities of cardiac electrical conduction may also be influenced by blood glucose.     

急性心肌梗塞患者的高胰岛素血症

检测１３例合并糖尿病的急性心肌梗塞（ＡＭＩ），２３例无糖尿病ＡＭＩ患者的空腹血胰岛素和Ｃ肽水平，并与２０例正常人作比较，发现两组均存在高胰岛素血症，合并糖尿病的ＡＭＩ组更为明显。１０例ＡＭＩ患者４周后复查，血胰岛素水平有显著下降。提示胰岛素在ＡＭＩ发病中有意义。     

Recovery of BMIPP uptake and regional wall motion in insulin resistant patients following angioplasty for acute myocardial infarction.

The effect of insulin resistance (IR) on the fatty acid metabolism of myocardium, and therefore on the recovery of left ventricular (LV) wall motion, has not been established in patients with acute myocardial infarction (AMI). A total of consecutive 58 non-diabetic AMI patients who had successfully undergone emergency coronary angioplasty were analyzed retrospectively. They were categorized into 2 groups, normal glucose tolerance (NGT) and impaired glucose tolerance (IGT), based on a 75-g oral glucose tolerance test (OGTT). The parameters of OGTT, myocardial scintigraphy (n=58) (thallium-201 (Tl) and iodine-123-beta-methyl-iodophenylpentadecanoic acid (BMIPP)) and left ventriculography (n=24) were compared in the 2 groups after reperfusion (acute phase) and 3-4 weeks after the AMI (chronic phase). The insulin resistance (IR), estimated by the serum concentration of insulin at 120 min (IRI 120') of the OGTT and by the HOMA (the homeostasis model assessment) index, was higher in the IGT group than in NGT group. An inverse correlation was found between the recovery of regional LV wall motion in the ischemic lesion and the IRI 120' and HOMA index. Although the recovery of BMIPP uptake from the acute to the chronic phase was higher in the IGT group, it was only correlated with the degree of IRI 120', not with the HOMA. IR accompanied by IGT can negatively influence the recovery of regional LV wall motion.     

Prevalence of Hyperglycaemia and Undiagnosed Diabetes Mellitus in Patients with Acute Myocardial Infarction

ABSTRACT The prevalence of hyperglycaemia and undiagnosed diabetes mellitus was assessed in 214 consecutive patients admitted to the coronary care units with acute myocardial infarction (AMI). On admission, 16 patients (7.5%) had known diabetes, and 19 patients, not previously known to be diabetic, had blood glucose concentrations of ≥9 mmol/1. Fifteen patients survived for 2 months at which time a 75 g oral glucose tolerance test showed diabetes in 9 (60%) and impaired glucose tolerance in 4 (27%). Ten of these 13 patients (77%) with abnormal glucose tolerance had elevated glycosylated haemoglobin (HbA_1c) on admission, indicating pre-existing glucose intolerance or diabetes. The prevalence of undiagnosed diabetes was 4.5% (9/198). However, we may have overlooked undiagnosed diabetes in a small number of patients on admission, since only a random blood glucose <8 mmol/1 rules out diabetes, WHO criteria. Elevated blood glucose in patients with AMI is more likely to reflect a stationary pre-existing abnormal glucose tolerance than a temporary stress-induced phenomenon.     

Stress hyperglycemia and enhanced sensitivity to myocardial infarction

In patients admitted to intensive care units with an acute myocardial infarction (AMI), the concomitant occurrence of hyperglycemia enhances the risk of morbidity and mortality, whether or not the patient has a prior diagnosis of diabetes. Stress hyperglycemia shares many properties with hyperglycemia associated with type 2 diabetes, including increased oxidative stress, inflammation, and activation of stress-responsive kinases. Infarcts are usually larger in patients with stress or diabetes-related hyperglycemia, and animals with type 2 diabetes sustain dramatically larger infarcts following experimental ischemia-reperfusion than do nondiabetic controls. Increased sensitivity to ischemia-reperfusion injury and more severe infarction is one reason for the poor prognosis of AMI patients with stress hyperglycemia. Evidence from clinical and preclinical studies suggests that insulin resistance and glucose homeostasis play key roles by predisposing hyperglycemic myocardial tissue to injury during ischemia and reperfusion.     

Abnormal glucose tolerance--a common risk factor in patients with acute myocardial infarction in comparison with population-based controls

BACKGROUND: A high prevalence of newly detected diabetes and impaired glucose tolerance (abnormal glucose tolerance) was recently reported in patients with acute myocardial infarction. It is important to verify whether this finding is specific for the patients or attributable to the population, from which they were recruited. OBJECTIVE: To verify whether abnormal glucose tolerance is more prevalent in patients than in controls chosen from the same population and to compare metabolic characteristics between the two groups. DESIGN AND SUBJECTS: The metabolic state was assessed in patients (n = 181) admitted with acute myocardial infarction and no history of diabetes before discharge and after 3 months. Sex- and age-matched controls (n = 185) without previously known diabetes or cardiovascular disease except hypertension were recruited from the general population. MAIN OUTCOME MEASURES: Oral glucose tolerance test, glucosylated haemoglobin A1c (HbA1c), insulin, proinsulin, lipid profile, fibrinolytic function and inflammatory markers. RESULTS: Abnormal glucose tolerance was more common (number/all classified) in patients at discharge 113/168 (67%) and after 3 months 95/145 (66%) than in controls 65/185 (35%) (P < 0.001). Dyslipidaemia (70% vs. 29%; P < 0.001) and previously treated hypertension (32% vs. 18%; P = 0.028) were more frequent amongst patients whilst obesity (18% vs. 24%) did not differ significantly. Blood glucose, HbA1c, proinsulin, proinsulin/insulin ratio, triglycerides, insulin resistance (by HOMA) and fibrinogen were consistently higher in patients than controls (P < 0.01). CONCLUSIONS: Abnormal glucose tolerance was almost twice as common amongst patients with acute myocardial infarction as in matched controls. Impaired glycaemic control accompanied by insulin resistance, dyslipidaemia, hypertension, together with increased plasma fibrinogen and proinsulin levels were main features characterizing patients.     

糖代谢异常患者急性心肌梗死行急诊经皮冠状动脉介入治疗后脂联素水平的变化

目的了解急性心肌梗死患者的糖代谢状态,观察糖代谢异常急性心肌梗死患者行急诊经皮冠状动脉介入治疗后脂联素水平的变化。方法连续入选2010年7月至2011年9月首都医科大学附属北京友谊医院心血管中心住院治疗的首次急性心肌梗死患者共206例。对无糖尿病病史的患者住院期间行口服葡萄糖耐量试验,根据检查结果及既往有无糖尿病病史分为正常糖耐量、糖调节受损与糖尿病3组。分别于PCI手术前后、发病24、48、72 h、7 d检测脂联素水平,观察其变化趋势。结果 (1)58例(28.2%)患者入院前已确诊为2型糖尿病,无糖尿病病史的患者中46.6%的患者为糖调节异常,10.8%新诊断为2型糖尿病,全部病例中69.4%的患者合并糖代谢异常。(2)糖代谢异常组患者的即刻血糖[(11.50±4.40)mmol/L、(8.22±1.38)mmol/L比(6.42±0.86)mmol/L]、空腹血糖水平[(9.23±4.11)mmol/L、(6.37±1.81)mmol/L比(5.19±0.79)mmol/L]均显著高于正常糖耐量组(均为P<0.05);糖尿病组的左心室射血分数明显低于其他两组(51.82%±7.02%比54.70%±7.98%、54.75%±7.72%,均为P<0.05);糖尿病组在PCI手术前后、发病后48、72 h与7 d脂联素水平均较正常糖耐量组低[(13.42±1.73)μg/ml比(15.37±1.73)μg/ml、(12.92±2.45)μg/ml比(14.71±1.61)μg/ml、(11.32±3.37)μg/ml比(12.48±2.64)μg/ml、(11.55±3.05)μg/ml比(13.13±2.55)μg/ml、(11.89±2.92)μg/ml比(13.56±2.36)μg/ml,均为P<0.05],糖尿病组在PCI手术前后、发病后72 h与7 d脂联素水平均低于糖调节受损组[(13.42±1.73)μg/ml比(15.61±1.60)μg/ml、(12.92±2.45)μg/ml比(14.76±1.65)μg/ml、(11.55±3.05)μg/ml比(12.61±2.13)μg/ml、(11.89±2.92)μg/ml比(13.18±2.04)μg/ml,均为P<0.05];各组PCI术后脂联素水平均较术前降低(均为P<0.05)。结论糖尿病的急性心肌梗死患者脂联素水平低于正常糖耐量组和糖调节受损组的患者;正常糖耐量组、糖调节受损组及糖尿病组PCI术后脂联素水平均较术前显著降低,于发病后24 h各组脂联素水平降至最低值,随后逐渐回升。     

Content of sugar and immunoreactive insulin in the blood of patients with myocardial infarct]

The content of sugar in the blood and that of immunoreactive insulin was determined in myocardial infarction cases on the 1st, 7th and 30th day. On the 30th day the carbohydrates tolerance test was conducted, and the content of immunoreactive insulin was determined after a glucose provocation. The assessment of glycemia and of the content of immunoreactive insulin was made in accordance with the type of the sugar curve. Hyperglycemia during the acute period of myocardial infarction was detected in 1/3 of the patients, a decrease of carbohydrates tolerance--2/3. Transient hyperglycemia was observed in persons in whom the glycemic and insulinemic curves resembled those in diabetes mellitus. The patients of this group displayed the same symptoms as those with diabetes mellitus. The dynamics of the content of the immunoreactive insulin from day to day of the disease differed in patients with transient hyperglycemia from those with normoglycemia.     

Acute hyperglycemia in patients with acute myocardial infarction

Acute hyperglycemia is a common feature during the early phase after acute myocardial infarction (AMI), regardless of diabetes status. Numerous studies have demonstrated that patients with AMI and hyperglycemia on admission have high rates of mortality. It has been reported that there is a linear positive relation between admission blood glucose levels and mortality after AMI. However, recent studies showed that the relationship is U-shaped in patients with a history of diabetes. Diabetic patients with moderate hyperglycemia (glucose 9-11 mmol/L) had the lowest mortality and not only severe hyperglycemia (glucose ≥ 11 mmol/L) but also euglycemia (glucose < 7 mmol/L) was associated with higher mortality. Although it has been debated whether acute hyperglycemia is causally related to adverse outcomes after AMI or is simply an epiphenomenon of severely damaged myocardium, multiple physiological studies have demonstrated that hyperglycemia has a direct detrimental effect on ischemic myocardium through several mechanisms, including oxidative stress, inflammation, apoptosis, endothelial dysfunction, hypercoagulation, platelet aggregation and impairment of ischemic preconditioning. Current guidelines recommend the use of an insulin-based regimen to achieve and maintain glucose levels < 10.0 mmol/dl, and emphasize the avoidance of hypoglycemia. However, the optimal management goal of glucose levels for patients with acute hyperglycemia remains uncertain. Further studies are warranted into the appropriate management in patients with AMI and acute hyperglycemia.     

Hyperglycaemia following acute myocardial infarction: the contribution of undiagnosed diabetes

We studied 397 patients admitted to hospital with acute myocardial infarction (AMI) to validate an admission level of haemoglobin A1c (HbA1c) diagnostic for previously unknown diabetes mellitus by assessing glucose tolerance after 3 months. In 38% of survivors clearly abnormal HbA1c level (greater than 7.8) was 100% sensitive and 99% specific for diabetes with fasting hyperglycaemia, although the sensitivity fell to 67% when three diabetic subjects without fasting hyperglycaemia were included. Admission hyperglycaemia (plasma glucose greater than or equal to 11 mmol/l) was present in 20% of patients with AMI, of whom only one in five had levels of HbA1c indicating prior diabetes. Glycosylated haemoglobin is a more sensitive and specific test for diabetes in patients with AMI than admission hyperglycaemia. Undiagnosed diabetes was found in 4.3% of subjects with AMI who contributed 9.6% of hospital mortality.     

非糖尿病患者ST段抬高急性心肌梗死胰岛素抵抗与临床预后关系

目的探讨非糖尿病患者急性心肌梗死时胰岛素抵抗的相关危险因素,并评估胰岛素抵抗对ST段急性心肌梗死患者住院期间预后的影响和意义。方法从2008年10月到2009年9月,连续入选初次发生ST段抬高急性心肌梗死,且在发病24小时内接受急诊经皮冠状介入治疗的患者,在入院第二天清晨测空腹血糖和胰岛素浓度,出院前均进行口服葡萄糖耐量试验,最后纳入非糖尿病患者124例,以稳态模型胰岛素抵抗指数,即HOMA-IR≥2.5认为存在胰岛素抵抗,评价胰岛素抵抗对急性心肌梗死患者预后的影响。结果 124例患者中,存在胰岛素抵抗的患者占49.2%（61/124）,病死率占12.1%（15/124）。胰岛素抵抗组较对照组有较高的入院血糖[（7.88±2.83）mmol/L比（6.93±1.60）mmol/L,P=0.025]、空腹血糖[（7.36±2.33）mmol/L比（6.43±1.81）mmol/L,P=0.014]和胰岛素浓度[（16.68±6.98）mU/L比（6.32±2.32）mU/L,P=0.000],组间比较差异具有统计学意义。多元逐步回归方程提示,体重指数[标准化回归系数（β）=0.244,P=0.021]和空腹血糖（β=0.451,P=0.000）是影响HOMA-IR严重程度的主要因素。多因素logistic回归方程提示,在调整其他因素后,胰岛素抵抗[OR=1.506,95%CI（1.062～2.134）,P=0.021]、Killip分级≥Ⅱ[OR=3.007,95%CI（1.165～7.779）,P=0.023]和心肌肌酸激酶同工酶峰值[OR=1.004,95%CI（1.000～1.008）,P=0.036]是急性心肌梗死患者住院期间死亡的独立危险因素。结论心肌梗死急性期胰岛素抵抗现象普遍存在,是急性心肌梗死患者住院期间预后不良的独立危险因素,体重指数和第二天空腹血糖水平是影响胰岛素抵抗的主要因素。     

Causes of death and prognosis of myocardial infarction in patients with diabetes

The long-term prognosis and causes of death of myocardial infarction (MI) in 62 patients with diabetes were studied. The mean follow-up time was 6.2 years. 11 cases died in the acute period of MI (8 weeks following onset of AMI), 9 cases of them (81.8%) had anterior infarction and their major causes of death were ventricular fibrillation and cardiogenic shock (72.2%). 19 cases died in the follow-up period, among them 14 cases (73.68%) had inferior and anterior-septal infarction; most of them died of reinfarction and sudden death. The cumulative survival rate 1.2 and 5 years after MI was 80.7%, 71.9% and 57.9%, respectively. The blood glucose level of the fatal group and the level of CPK and GOT of patients who died in the acute period were higher than those in the surviving group. The results suggest that treatment of myocardial infarction in patients with diabetes be more attentive to prevent ventricular fibrillation and cardiogenic shock during the acute period. After the acute period more attention should be paid to prevent reinfarction and and drop the blood glucose level at normal as possible.     

急性心肌梗塞左心功能与胰岛素抵抗的关系

为探讨急性心肌梗塞恢复期患者左心功能与胰岛素抵抗的关系，对26例急性心肌梗塞恢复期患者和20例健康人进行口服葡萄糖耐量试验、胰岛素和C肽释放试验，并应用多普勒超声心动图仪探测急性心肌梗塞患者左心室收缩和舒张功能。结果发现左心室射血分数＜0.50的患者（LEF组）、左心室射血分数＞0．50的患者（NEF分数）和正常组空腹血糖浓度接近，而空腹胰岛素水平却LEF组＞NEF组＞正常组，胰岛素敏感性指数三组依次增大；LEF、NEF两组糖耐量受损与异常增高的胰岛素释放反应并存，LEF组胰岛素释放反应强度大于NEF组；某些收缩功能参数（主要是左心室射血分数）与多个胰岛素抵抗参数显著相关。提示急性心肌梗塞恢复期患者左心室收缩功能受损与胰岛素抵抗程度相关联。     

Altered plasma concentrations of glutamate, alanine and citrate in the early phase of acute myocardial infarction in man

Plasma levels of glutamate, alanine, free fatty acids (FFA),citrate, glucose, insulin, lactate, creatine kinase and aspartateaminotransferase were determined frequently during the first2–48 h after onset of chest pain 10 patients who developedacute myocardial infarction (AMI) and in 8 who did not (non-AMI). An initial decrease in plasma glutamate and increase in alaninewas found in AMI compared to non-AMI patients. The AMI groupshowed early, moderate rises of plasma FFA and citrate concentrations,positively related to the initial ST-segment elevation and tothe enzymatic estimated infarct size. The AMI patients werecontinuously hyperglycaemic, but their relative insulin responsei.e. plasma glucose/insulin ratio was identical to that of non-AMIpatients. Lactate values did not differ between the two groups. Via participation in the malate–aspartate shuttle andby shunting pyruvate to alanine instead of lactate, glutamateis of importance for maintaining myocardial glucose utilization.Our finding of initial low plasma glutamate concentrations afteronset of myocardial infarction suggests insufficient glutamatesupply to the ischaemic myocardium. On basis of this and animalexperiments, an external supply of glutamate might be a ‘metabolic’treatment of AMI, alternative or additional to glucose-insulin-potassiuminfusion in order to promote myocardial glucose oxidation.     

Oral glucose tolerance,insulin and gastric inhibitory polypeptide secretion in patients recovered from acute myocardial infarction

Summary Ten male patients, recovered from acute myocardial infarction, and ten control subjects were investigated by a 50 g oral glucose tolerance test. All patients and control subjects had normal glucose tolerance, but the patients had increased fasting and integrated insulin response to oral glucose. Fasting gastric inhibitory polypeptide concentrations and integrated gastric inhibitory polypeptide response were normal in the patients. The exaggerated insulin secretion in patients recovered from myocardial infarction does not seem to be caused by increased secretion of gastric inhibitory polypeptide.     

Is admission hyperglycaemia in non-diabetic patients with acute myocardial infarction a surrogate for previously undiagnosed abnormal glucose tolerance?

AIMS: To investigate whether admission hyperglycaemia in non-diabetic patients with acute myocardial infarction (AMI) is a surrogate for previously undiagnosed abnormal glucose tolerance. METHODS AND RESULTS: Two hundred non-diabetic patients with AMI were divided into three groups: 81 patients with admission glucose < 7.8 mmol/L (group 1), 83 patients with admission glucose > or = 7.8 mmol/L and < 11.1 mmol/L (group 2), and 36 patients with admission glucose > or = 11.1 mmol/L (group 3). Abnormal glucose tolerance, diabetes, or impaired glucose tolerance (IGT) was diagnosed by oral glucose tolerance test (OGTT). OGTT identified diabetes in 53 patients (27%) and IGT in 78 patients (39%). When the fasting glucose criteria were applied, however, only 14 patients (7%) were diagnosed as having diabetes. The prevalence of abnormal glucose tolerance was similar among the three groups: 67% in group 1, 63% in group 2, and 69% in group 3 (P = 0.74). The relation of fasting glucose (r2 = 0.50, P < 0.001) and HbA1c (r2 = 0.34, P < 0.001) to 2-h post-load glucose was significant, but the relation of admission glucose to 2-h post-load glucose was not significant (r2 = 0.02, P = 0.08). Multivariable analysis showed that fasting glucose and HbA1c were independent predictors of abnormal glucose tolerance, but admission glucose was not. CONCLUSION: Admission hyperglycaemia in non-diabetic patients with AMI does not represent previously undiagnosed abnormal glucose tolerance. Fasting glucose and HbA1c, rather than admission glucose, may be useful to predict abnormal glucose tolerance. However, these parameters lacked sensitivity. OGTT should be considered in all non-diabetic patients with AMI.