Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction

Prasad, Abhiram; Stone, Gregg W.; Stuckey, Thomas; Costantini, Costantino O.; Zimetbaum, Peter; McLaughlin, Michael G.; Mehran, Roxana; Garcı́a, Eulogio; Tcheng, James E.; Cox, David A.; Grines, Cindy L.; Lansky, Alexandra J.; Gersh, Bernard J.

doi:10.1016/j.jacc.2004.10.054

Cited by 112 publications

(64 citation statements)

References 34 publications

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“…25 Despite similar high rates of TIMI flow grade 3 after primary PCI in patients with and without diabetes, DM was an independent predictor of absent myocardial perfusion (MPG 0/1) (hazard ratio …”

Section: Primary Pci In Diabetic Patientsmentioning

confidence: 96%

“…31,32 These deleterious consequences of abnormal glucose metabolism on microvascular perfusion have been well documented using new modalities to quantify myocardial reperfusion in patients treated with primary stent PCI. 25,33 The no-reflow phenomenon, which corresponds to a closed muscle, was found more often in patients with hyperglycaemia than in those without hyperglycaemia and the blood glucose level on admission was found to be an independent prognostic factor for no reflow (figure 5). Whether decreased microvascular perfusion accounts for the higher rate of mortality has been a subject of debate.…”

Section: Why Do Reperfusion Therapies Fail In Diabetics With Stemi?mentioning

confidence: 99%

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

Collet

Montalescot

2005

Diabetes and Vascular Disease Research

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Diabetes mellitus (DM) remains an important predictor for mortality in patients with ST-segment Elevation Myocardial Infarction (STEMI) although the use of reperfusion therapy has resulted in a considerable improvement of survival. Of importance, newly diagnosed diabetic patients and those with fasting glycaemia in the diabetes range have even worse outcomes compared to patients with known diabetes. Overall, 50% of all patients presenting with STEMI have abnormal glucose metabolism of which fewer than 50% are known diabetics. Obviously, the efficacy of reperfusion therapy in reopening the occluded artery is similar in STEMI patients with or without impaired fasting glycaemia, while the pre-existing decreased myocardial perfusion in STEMI patients with impaired fasting glycaemia persists after successful epicardial revascularisation.There is no doubt that improving microvascular perfusion within the ischaemic myocardium remains the ultimate goal of managing STEMI patients with impaired glucose metabolism. Identification of defective myocardial perfusion together with an aggressive antithrombotic regimen, reduction of the inflammatory response of the ischaemic myocardium and improvement of glycaemia control represent promising therapeutic approaches that deserve additional specific clinical investigations. This review examines all these important issues. 2005;2:136-43 Diabetes Vasc Dis Res

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Section: Primary Pci In Diabetic Patientsmentioning

confidence: 96%

Section: Why Do Reperfusion Therapies Fail In Diabetics With Stemi?mentioning

confidence: 99%

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

Collet

Montalescot

2005

Diabetes and Vascular Disease Research

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“…No-refl ow phenomenon is found in 25% to 30% patients with AMI, despite successful coronary reperfusion and is associated with a worse outcome (17,18). Studies have demonstrated that acute hyperglycemia is associated with reduced spontaneous coronary perfusion and impaired tissue perfusion as compared to euglycemia (19,20). In a study of Iwakaru et al (6), patients with AMI and no-refl ow phenomenon were found to have higher blood glucose levels on admission than did those without no-refl ow phenomenon despite the similar frequency of DM and similar levels of hemoglobin A1C values of the two groups.…”

Section: Discussionmentioning

confidence: 99%

Relationship between TIMI frame count and admission glucose values in acute ST elevation myocardial infarction patients who underwent successful primary percutaneous intervention

Ege

Güray²,

Güray³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Akut miyokart enfarktüsü ile başvuran hastalarda hiperglisemi olumsuz prognozla ilişkilidir. Primer perkütan koroner girişim (PKG) yapılan hastalarda, enfarkttan sorumlu arterin işlem sonu Miyokart Enfarktüste Trombolizis (TIMI) kare sayıları başarılı reperfüzyona rağmen önemli oranda farklılık gösterebilmektedir. Bu prospektif gözlemsel çalışmada ST yükselmeli miyokart enfarktüsü (STYMİ) sebebi ile başarılı primer PKG uygulanan hastalarda başvuru glikoz değerleri ile işlem sonucunda sorumlu koroner arter TIMI kare sayılarının ilişkisi araştırılmıştır. Yöntemler: Altı aylık zaman süresi içerisinde, STYMİ ile başvuran ve PKG ile TIMI 3 akım sağlanan ardışık 73 diyabetes mellitusu olmayan hasta çalışmaya dahil edilmiştir. Hastalar TIMI kare sayılarına göre iki gruba bölünmüştür. Grup 1 (n=53), enfarkttan sorumlu koroner arter TIMI kare ABSTRACT Objective: Admission hyperglycemia is associated with poor prognosis in patients with acute myocardial infarction. Final Thrombolysis in Myocardial Infarction (TIMI) frame counts of culprit coronary arteries may show significant variability despite successful coronary reperfusion after primary percutaneous coronary intervention (PCI). In this prospective observational study, relationship between final TIMI frame counts of the culprit coronary artery and admission glucose values was investigated in patients who underwent successful primary PCI due to acute ST-elevation myocardial infarction (STEMI). Methods: During a 6-month period of time, 73 non-diabetic patients presented with acute STEMI who have undergone primary PCI with final TIMI 3 flow were consecutively included in the study. Patients were divided into two groups according to final TIMI frame counts. Group 1 (n=53) consisted of patients with final TIMI frame counts of the culprit coronary artery within the two standard deviation of predefined values and Group 2 (n=20) consisted of those with higher TIMI frame counts. Statistical analysis was performed using Chi-square, Mann-Whitney U tests and multiple linear regression analysis. Results: Despite similar fasting glucose values, admission glucose levels were significantly higher in Group 2 as compared to vs. 123 mg/dl, p=0.03). In whole group, admission glucose values were significantly correlated with corrected TIMI frame counts of culprit coronary arteries (r=0.30, p=0.01). In addition, there were significant association between admission glucose values and peak creatine kinase-MB (r=0.36, p=0.007) values as well as left ventricular ejection fraction (r=-0.43, p=0.009). In multiple linear regression analysis, only admission glucose value was found to be significantly related to the final TIMI frame count of the culprit artery (β=0.04, 95% CI: 0.02-0.085, p=0.04). Conclusion: High admission glucose values were significantly associated with impaired coronary flow even after successful primary PCI in non-diabetic patients with STEMI. (Anadolu Kardiyol Derg 2011; 11: 213-7)

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“…However, no data were reported on myocardial perfusion. In fact, diabetes has been shown to be associated with impaired reperfusion (16).…”

Section: L I N I C a L C A R E / E D U C A T I O N / N U T R I T I mentioning

confidence: 99%

Impact of Routine Stenting on Clinical Outcome in Diabetic Patients Undergoing Primary Angioplasty for ST-Segment Elevation Myocardial Infarction

et al. 2006

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Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction

Cited by 112 publications

References 34 publications

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

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

Relationship between TIMI frame count and admission glucose values in acute ST elevation myocardial infarction patients who underwent successful primary percutaneous intervention

Impact of Routine Stenting on Clinical Outcome in Diabetic Patients Undergoing Primary Angioplasty for ST-Segment Elevation Myocardial Infarction

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