Ischaemic heart disease

High incidence of undiagnosed diabetes mellitus in patients with AMI ▸ Of 181 consecutive non-diabetic patients with acute myocardial infarction (AMI), 35% (95% confidence interval (CI) 28% to 43%) and 40% (95% CI 32% to 48%) had impaired glucose tolerance at discharge and after three months, respectively, while 31% (95% CI 24% to 38%) and 25% (95% CI 18% to 32%) had previously undiagnosed diabetes mellitus. Independent predictors of abnormal glucose tolerance at three months were concentrations of HbA_1c at admission (p = 0.024) and fasting blood glucose concentrations on day 4 (p = 0.044).

Prevention of NIDDM with acarbose ▸ Over 1400 patients with impaired glucose tolerance were randomly allocated to 100 mg acarbose or placebo three times daily. At a mean follow up of 3.3 years, 211 (31%) of 682 patients in the acarbose group and 130 (19%) of 686 on placebo had discontinued treatment. Non-insulin dependent diabetes mellitus (NIDDM) developed in 221 (32%) patients randomised to acarbose and 285 (42%) randomised to placebo (relative hazard 0.75, 95% CI 0.63 to 0.90; p = 0.0015). The most frequent side effects to acarbose treatment were flatulence and diarrhoea.

Troponins are still predictive in patients with ACS plus renal failure ▸ Troponin T is renally cleared and so may remain elevated for long periods in patients with renal impairment. In the GUSTO IV trial, death or myocardial infarction occurred in 581 of > 7000 patients. Among patients with a creatinine clearance above the 25th centile value of 58.4 ml per minute, an abnormally elevated troponin T concentration (> 0.1 ng/ml) was predictive of an …