Diabetes Mellitus is Associated with Insufficient Microvascular Reperfusion following Revascularization for Anterior Acute Myocardial Infarction

Abstract

Objective The purpose of this study was to test the hypothesis that lack of microvascular reperfusion following revascularization might be associated with a poor clinical outcome in diabetic patients with acute myocardial infarction (AMI).Methods Westudied 134 patients with a first anterior AMI whounderwent successful revascularization within 6 hours. Weassessed microvascular reperfusion by using electrocardiogram recordings just before revascularization and on return to the coronary care unit. Lack of microvascular reperfusion was defined as the absence of decrease of >20%in the sum of ST segment elevation (EST).Results Twenty-four patients had diabetes and 110 patients did not. EST before revascularization was similar between diabetic and nondiabetic patients. After revascularization, reduction of UST was significantly smaller (1.3±8.4 mm vs 6.5±10.8 mm, p=0.03), and lack of microvascular reperfusion was significantly more frequent (62.5% vs 33.6%, p=0.01) in diabetic patients. A multivariate analysis showedthat diabetes was associated with insufficient microvascular reperfusion (odds ratio 3.18, p=0.03).Major adverse cardiac events occurred more frequently in patients with a lack of microvascular reperfusion (30.8% vs 15.9%, p=0.04). Conclusion These findings suggest that lack of microvascular reperfusion following revascularization may be one of the mechanisms of a poor clinical outcome in diabetic patients with AMI. (Internal Medicine 42: 554-559, 2003)

The Assessment of Endothelial Function

“…Diabetes, and the accumulation of risk factors in the metabolic syndrome, for example, have significant deleterious effects on myocardial perfusion and infarct size in patients with an acute infarction. 143, 144, 145, 146 Moreover, patients with pre-procedural impairment of microvascular function are more likely to have post-procedural microvascular impairment as well as procedure-related injury and a worse outcome. 147 Thus, pre-existing microvascular endothelial dysfunction leads to a greater vulnerability to myocardial injury, highlighting the potentially clinically relevant role of a dysfunctional microcirculation and damage.…”

Increased Cardiac Mortality in Women Compared with Men in Patients with Acute Myocardial Infarction

“…The reason why being a women by itself is an independent predictor of in-hospital mortality in the patients with UAP is unclear, but may relate to poorer myocardial reserve in the women suggested by diastolic dysfunction (7), and reduced collateral blood flow (16). Moreover, the number of leads with ST depression during an anginal attack (25), absence of persistent ischemic chest pain (26), and lack of microvascular reperfusion following revascularization (27) were independent risk predictors of clinical outcome. Japanese women with ACS present with similar angiographic findings and hemodynamics, but have a higher in-hospital mortality rate than male patients.…”

Coronary arterial BK channel dysfunction exacerbates ischemia/reperfusion-induced myocardial injury in diabetic mice

“…Diabetes is associated with a 2-to 4-fold increase in the risks of cardiovascular diseases which remain the leading cause of death in both men and women with diabetes (Snell-Bergeon & Wadwa, 2012). A large body of clinical evidence has shown that the poor prognosis of acute myocardial infarction and cardiac sudden death in patients diagnosed with diabetes is attributed to compromised coronary blood flow and increased susceptibility of myocardial ischemia (Kurisu et al, 2003;Cubbon et al, 2007;Yeung et al, 2012). Despite advances in the management of diabetes, the cardiovascular morbidity and mortality in diabetic patients remain twice that of non-diabetic patients (Wackers, 2005;Norhammar et al, 2007).…”