Hyperglycemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarction

Abstract

Hyperglycemia in patients with STEMI is an important predictor of impaired epicardial flow before reperfusion therapy has been initiated. Investigation of methods improving coronary flow before primary PCI in these patients is warranted.

Acute Hyperglycemia an Independent Risk Factor for Contrast-Induced Nephropathy in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI

“…Acute hyperglycemia is associated with several adverse effects that contribute to poor outcome in STEMI. They include increased oxidative stress, increased cytokine activation, Inflammatory response, endothelial dysfunction and impaired microcirculatory function as manifested by post-PCI no-reflow and impaired ischemic preconditioning [4,[21][22][23][24][25]. Hyperglycemia has also been shown to have several prothrombotic effects and enhanced platelet activation with subsequent increased risk for thrombotic events [26][27][28][29].…”

The acute reperfusion management of STEMI in patients with impaired glucose tolerance and type 2 diabetes

“…35,39 Hyperglycaemia in patients with STEMI is an important predictor of impaired epicardial flow before reperfusion therapy has been initiated. 40 In a series of 460 consecutive STEMI patients, TIMI flow grade 3 before primary PCI was observed less often in patients with hyperglycaemia (> 7.8 mmol/L) compared to patients without hyperglycaemia (12% vs. 28%, p<0.001). After adjustment for differences in baseline variables, hyperglycaemia was a strong predictor of absence of reperfusion before primary PCI (odds ratio 2.6, 95% CI 1.5 to 4.5).…”

Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock

“…Recent study of Mansour et al [7] confirmed that increased BG level (≥ 7.8 mmol/L) is an unfavorable prognostic factor also in patients with ACS. Hyperglycemia in these patients leads to higher levels of cardiac necrosis markers and lower left ventricular ejection fraction [9,22]. It also leads to increased endothelial dysfunction, hypercoagulability and impaired fibrinolysis [23,24].…”

“…The prevalence of admission hyperglycemia (glucose levels ≥ 7.8 mmol/L) in different epidemiological studies ranges from 51% to > 58% of patients hospitalized with AMI [8]. Increased glucose level on admission is an independent factor of more impaired initial flow in the infarct-related artery and occurrence of no-reflow phenomenon [9]. In addition, patients with hyperglycemia have higher Killip class, a larger infarct and worse left ventricular (LV) function [10].…”