Metabolic syndrome influencing infarct size and heart failure in patients with acute coronary syndrome — does gender matter?

Kranjčec, Darko; Altabas, Velimir

doi:10.1507/endocrj.ej12-0131

Cited by 11 publications

(5 citation statements)

References 42 publications

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“…Acute hyperglycemia was related to limited ST-E recovery in mixed diabetic and non-diabetic STEMI population after thrombolytic therapy [ 62 ] and after pPCI [ 63 ]. Metabolic syndrome (chronic IR) was a predictor of ST-E resolution after pPCI [ 11 ]. In the current study in patients without diabetes, incomplete ST-E resolution was significantly more frequent among those with acute IR.…”

Section: Discussionmentioning

confidence: 99%

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Trifunović

Stanković

Šobić-Šaranović

et al. 2014

Cardiovasc Diabetol

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BackgroundInsulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI).MethodsIn 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2nd and 7th day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2nd day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices.ResultsIR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (p = 0.001) and day 7 (p < 0.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (r = 0.331), whereas both HOMA indices correlated well with CFR (r = -0.331 to -0.386) (p < 0.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2 mm (OR 11.70, 95% CI 2.46-55.51, p = 0.002) and CFR < 2 (OR = 5.98, 95% CI 1.88-19.03, p = 0.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, p = 0.026).ConclusionIR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size.

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Section: Discussionmentioning

confidence: 99%

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Trifunović

Stanković

Šobić-Šaranović

et al. 2014

Cardiovasc Diabetol

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“…Clavijo et al in a comparison between 167 non-diabetic patients with metabolic syndrome and 133 control patients without metabolic syndrome or diabetes mellitus demonstrated larger infarct size and higher in-hospital complications in patients with metabolic syndrome ( 48 ). In another study, Kranjcec et al in a study on 141 patients with metabolic syndrome and 89 control patients presenting with acute coronary syndrome, also showed that patients with metabolic syndrome had larger infarct size ( 49 ). Similar to our study, these two studies have used peak CK-MB to determine the infarct size ( 48 , 49 ).…”

Section: Discussionmentioning

confidence: 98%

“…In another study, Kranjcec et al in a study on 141 patients with metabolic syndrome and 89 control patients presenting with acute coronary syndrome, also showed that patients with metabolic syndrome had larger infarct size ( 49 ). Similar to our study, these two studies have used peak CK-MB to determine the infarct size ( 48 , 49 ). On the other hand, Bohmer et al in a cross-sectional study including 152 patients (33 patients with metabolic syndrome) found no significant difference in median infarct size, as assessed by late gadolinium enhanced magnetic resonance imaging, between patients with and without metabolic syndrome ( 50 ).…”

Section: Discussionmentioning

confidence: 98%

Metabolic syndrome is associated with higher wall motion score and larger infarct size after acute myocardial infarction

Hajsadeghi¹,

Chitsazan²,

Chitsazan³

et al. 2015

Res Cardiovasc Med

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Background:Infarct size is an important surrogate end point for early and late mortality after acute myocardial infarction. Despite the high prevalence of metabolic syndrome in patients with atherosclerotic diseases, adequate data are still lacking regarding the extent of myocardial necrosis after acute myocardial infarction in these patients.Objectives:In the present study we aimed to compare myocardial infarction size in patients with metabolic syndrome to those without metabolic syndrome using peak CK-MB and cardiac troponin I (cTnI) at 72 hours after the onset of symptoms.Patients and Methods:One-hundred patients with metabolic syndrome (group I) and 100 control subjects without metabolic syndrome (group II) who experienced acute myocardial infarction were included in the study. Diagnosis of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines published in 2001. Myocardial infarction size was compared between the two groups of patients using peak CK-MB and cTnI level in 72 hours after the onset of symptoms.Results:Peak CK-MB and cTnI in 72 hours were found to be significantly higher in patients with metabolic syndrome compared with control subjects (both P < 0.001). Patients with metabolic syndrome also had markedly higher wall motion abnormality at 72 hours after the onset of symptoms as assessed by echocardiographically-derived Wall Motion Score Index (WMSI) (P < 0.001). Moreover, statistically significant relationships were found between WMSI and peak CK-MB and also cTnI at 72 hours (Spearman's rho = 0.56, P < 0.001 and Spearman's rho = 0.5, P < 0.001; respectively). However, association between WMSI and left ventricular ejection fraction was insignificant (Spearman's rho = -0.05, P = 0.46).Conclusions:We showed that patients with metabolic syndrome have larger infarct size compared to control subjects.

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“…The extent of angiographic lesions, size of infarct, and in-hospital and late prognosis in patients with MS have not been clearly determined. There have been only a few studies regarding this issue, with conflicting results [3][4][5][6][7][8]. As part of MS, insulin resistance (IR) is an important risk factor for the development of cardiovascular disorders.…”

Section: Introductionmentioning

confidence: 99%

Angiographic severity of coronary artery disease and cardiovascular risk in acute coronary syndrome in patients with metabolic syndrome

et al. 2018

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The associations between the angiographic severity of CAD and age, BMI, and insulin resistance (IR) confirm the involvement of these parameters in coronary atherosclerosis. The correlations between the estimated cardiovascular risk and IR indicate the prognostic value of metabolic parameters in patients after first ACS. The type of ACS is the strongest predictor of LVEF at discharge in this population.

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Metabolic syndrome influencing infarct size and heart failure in patients with acute coronary syndrome — does gender matter?

Cited by 11 publications

References 42 publications

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Metabolic syndrome is associated with higher wall motion score and larger infarct size after acute myocardial infarction

Angiographic severity of coronary artery disease and cardiovascular risk in acute coronary syndrome in patients with metabolic syndrome

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