Admission Hyperglycemia and TIMI Frame Count in Primary Percutaneous Coronary Intervention

Yıldız, Ahmet; Arat-Özkan, Alev; Kocas, Cuneyt; Abacı, Okay; Coşkun, Uğur; Bostan, Cem; Olcay, Ayhan; Aktürk, Faruk; Ökçün, Barış; Ersanlı, Murat; Gürmen, Tevfik

doi:10.1177/0003319711418957

Cited by 8 publications

(6 citation statements)

References 28 publications

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“…These changes may represent a prothrombotic state that leads to microvascular dysfunction and may be responsible for the failure of thrombolysis. Previous studies found deleterious effects of hyperglycemia in terms of coronary flow following primary PCI [26,27]. However, to our knowledge, this is the first study to demonstrate the effect of acute hyperglycemia on the success of fibrinolysis.…”

Section: Discussionmentioning

confidence: 58%

Admission Hyperglycemia Is Associated with Failed Reperfusion Following Fibrinolytic Therapy in Patients with STEMI: Results of a Retrospective Study

Kocas

Abacı

Halil

et al. 2014

Am J Cardiovasc Drugs

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Section: Discussionmentioning

confidence: 58%

Admission Hyperglycemia Is Associated with Failed Reperfusion Following Fibrinolytic Therapy in Patients with STEMI: Results of a Retrospective Study

Kocas

Abacı

Halil

et al. 2014

Am J Cardiovasc Drugs

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“…The results of studies analysing the impact of reactive hyperglycaemia on the final effect of the PCI procedure are well known. There is evidence that the higher the glucose values observed on admission, the greater the likelihood of slower inflow in coronary vessels -cTFC ≥ 28 [17,18]. In my own study I observed a similar trend between different groups of patients taking into account the blood glucose level on admission, although the differences were not statistically significant.…”

Section: Discussionmentioning

confidence: 69%

The significance of dynamics of ST segment changes when assessing the effectiveness of mechanical reperfusion of the myocardium in hyperglycaemic patients with acute myocardial infarction with persistent ST-segment elevation

Andres¹,

Legutko²,

Konduracka³

et al. 2020

J Integr Cardiol

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Background:The coexistence of coronary heart disease and consequently acute myocardial infarction with persistent ST-segment elevation (STEMI) and glucose metabolism disorders is well known. Still, glucose metabolism disorders in the STEMI population are not fully understood. We know that diabetes mellitus (DM) is a factor disabling the function of microcirculation, which in turn may affect the outcome of a coronary intervention. The aim of this study was to evaluate the dynamics of ST-segment changes in ECG (electrocardiogram) in STEMI (ST-segment elevation myocardial infarction) patients with co-existing hyperglycaemia compared to those with normoglycemia treated with percutaneous coronary intervention (PCI), as well as to determine this parameter in the assessment of reperfusion effectiveness. Methods:The study included 92 patients with the diagnosis of STEMI enrolled in the PCI treatment and was divided into groups based on the glucose levels on admission (reactive hyperglycaemia): a group with higher glucose levels on admission (Glc ≥ 7.8 mmol/L, n=46), a group with lower glucose levels on admission (Glc < 7.8 mmol/L, n=46) and into groups based on the concentration of HbA1c : a group with a lower HbA1c level (<6.5% (48 mmol/mol), n=71) and a group with a higher level (≥ 6.5%, n=21).Results: On admission there were no significant differences in terms of clinical characteristics between the groups of patients with normoglycemia and reactive hyperglycaemia. After PCI the patients with normoglycemia had significantly higher (p=0.021) dynamics of changes in the resolution of ST-segment elevation in ECG expressed in an indicator of sum STR (resolution of ST elevation). A degree of resolution of ST elevation in ECG was significantly (p=0.021) dependent on the level of blood glucose -the higher the blood glucose level, the weaker resolution. The patients with the glucose levels ≥ 7.8 mmol/L had significantly higher levels of CK and CK-MB during the first 48 hours of hospitalization. There was a statistically significant difference in the mean length of hospitalization between individuals from the group with lower and higher blood glucose levels on admission (p=0.028). A 4-month follow-up revealed no significant difference in the incidence of MACE in the study groups (p=0.063). A 4-year follow-up of patients with higher levels of blood glucose on admission showed a higher incidence of MACE (p=0.01).The patients with HbA1c ≥ 6.5% were older (p=0.004), had a greater BMI >30kg/m 2 (p=0.019) and the lower ejection fraction of the left ventricle (p=0.003) compared to those with the HbA1c levels <6.5%. The incidence of MACE in 4-month and 4-year follow-up was comparable in the study population.Conclusions: Myocardial reperfusion after primary angioplasty in acute myocardial infarction, which is determined by the degree of resolution of ST elevation in ECG, depends on the state of the glucose metabolism. The dynamics of changes in the ST-segment in ECG, taken immediately after PCI, is lower in patients with reactive hyperg...

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“…It has been implied that, regardless of diabetes history, admission with hyperglycemia has a close connection with mortality [31]. Yildiz et al reported that glucose on admission was independent of high TFC, regardless of diabetes history [32]. Recently, a study revealed that hyperglycemia affects coronary thrombus burden and inflammatory status, resulting in worse prognosis in patients undergoing interventional treatment [33].…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of Risk Nomogram Model Predicting Coronary Microvascular Obstruction in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Primary Percutaneous Catheterization

Xiao

Wang

et al. 2019

Med Sci Monit

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Background Coronary microvascular functional and structural obstruction (CMVO) remains a major complication in patients with ST-segment elevation myocardial infarction (STEMI). This study was designed to develop and validate a nomogram model to predict CMVO risk during primary percutaneous catheterization procedure. Material/Methods Starting January 2014 to December 2016, a cohort of eligible candidates were enrolled and divided into a training or a validation database. Each database was divided into MO or NMO subgroups based on TIMI myocardial perfusion grade results after recanalization. Independent factors were identified by multivariate logistic regression, from which the nomogram was plotted. The echocardiography measurement of the left ventricular ejection fraction (LVEF) was arranged within 7 days after the procedure. Results A nomogram was built for CMVO risk prediction for the first time. There were 446 participants in the training database with 319 cases in the NMO subgroup and 127 participants in the MO subgroup. The validation database included 99 participants with 25 cases in the NMO subgroup and 74 in the MO subgroup. The risk model was developed by 6 independently significant factors: age, symptom onset to balloon time, Killip classification, admission activated clotting time, neutrophil/lymphocyte ratio, and glucose value. Internal receiver operating characteristic displayed favorable performance with concordance index of 0.925, while external validation area under curve was 0.939. There were significant differences in LVEF values during hospitalization between the subgroups of each database (both P <0.001). Conclusions The nomogram model consisting of 6 factors could predict CMVO risk accurately for STEMI patients undergoing primary percutaneous catheterization.

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Admission Hyperglycemia and TIMI Frame Count in Primary Percutaneous Coronary Intervention

Cited by 8 publications

References 28 publications

Admission Hyperglycemia Is Associated with Failed Reperfusion Following Fibrinolytic Therapy in Patients with STEMI: Results of a Retrospective Study

Admission Hyperglycemia Is Associated with Failed Reperfusion Following Fibrinolytic Therapy in Patients with STEMI: Results of a Retrospective Study

The significance of dynamics of ST segment changes when assessing the effectiveness of mechanical reperfusion of the myocardium in hyperglycaemic patients with acute myocardial infarction with persistent ST-segment elevation

Development and Validation of Risk Nomogram Model Predicting Coronary Microvascular Obstruction in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) Undergoing Primary Percutaneous Catheterization

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