Role of impaired glucose tolerance in patients with acute myocardial infarction in relation to sex.

INTRODUCTION Impaired glucose tolerance (IGT) has a negative impact on the outcome of patients with acute myocardial infarction (AMI). OBJECTIVES The aim of the study was to compare the effect of IGT on early and late prognosis in women and men with AMI treated with percutaneous coronary intervention (PCI). PATIENTS AND METHODS Based on the results of oral glucose tolerance test, 560 patients with IGT (395 men, 165 women) were selected out of a single center registry of 2733 consecutive patients with AMI. Sex-related mortality and major adverse cardiovascular events (MACEs) including myocardial reinfarction, stroke, or repeat revascularization during hospitalization and long-term follow-up were compared in the whole study population and within the high-risk subgroups. RESULTS Mortality and MACE rates were comparable between men and women except for a higher stroke rate in women (4.8% vs. 1.5%, P <0.05). No significant differences were observed in the subgroups of patients with reduced ejection fraction (<35%) and those aged above 70 years, during both short and long-term follow-up. However, in women compared with men, higher stroke rates were observed in the subgroup of patients with incomplete revascularization (6.9% vs. 1.1%, P <0.05) and higher total mortality rates in the subgroup with renal dysfunction (40% vs. 16%, P <0.05). Female sex was an independent risk factor for stroke (hazard ratio [HR], 2.94; P = 0.048) and MACEs (HR, 1.45; P = 0.009), but not for death, in the population of patients with AMI and IGT. CONCLUSIONS Mortality in women and men with AMI treated with PCI with concomitant IGT is comparable, but female sex is an independent risk factor for stroke and MACEs, particularly worsening prognosis in patients with renal dysfunction.