Peri-Procedural Tight Glycemic Control during Early Percutaneous Coronary Intervention Is Associated with a Lower Rate of In-Stent Restenosis in Patients with Acute ST-Elevation Myocardial Infarction

Abstract

In hyperglycemic patients with STEMI, optimal peri-procedural glycemic control by reducing oxidative stress and inflammation may improve the outcome after PCI.

Newly diagnosed and previously known diabetes mellitus and short-term outcomes in patients with acute myocardial infarction

“…Marfella et al [18] indicated that tight glycemic control might have anti-inflammatory and antiremodeling effects during AMI. Finally, tight glycemic control may reduce the rate of in-stent restenosis in patients with STEMI who underwent PCI [19]. Thus, for patients with STEMI, intensive insulin therapy should be applied to ameliorate the detrimental effects because of stress hyperglycemia.…”

Clinical influence of early follow-up glycosylated hemoglobin levels on cardiovascular outcomes in diabetic patients with ST-segment elevation myocardial infarction after coronary reperfusion

“…In terms of persistent hyperglycemia after AMI, only a few studies have reported its effect on clinical outcomes [23][24][25]. Poor serum glycemic control after ischemic insults is common in patients with diabetes because some of the physiologic responses differ from those without diabetes.…”

“…Some studies have examined postprocedural serum glucose levels for short periods ranging from 24 h to 4 days, and observed MACE at 1 or 6 months [23,24,27]. In contrast to previous studies, we followed patients for 12 months and used FU-HbA1c instead of glucose levels.…”

Periprocedural Glycemic Control in Patients With Diabetes Mellitus Undergoing Coronary Angiography With Possible Percutaneous Coronary Intervention

“…Multiple trials attempting to demonstrate a benefit with glucose-insulin-potassium infusions have yielded conflicting results, possibly due to the failure to reach target glucose levels in the treatment arm. Finally, a recent study by Marefella et al, demonstrated optimal peri-procedural glycemic control in the setting of ST-segment elevation MI to reduce oxidative stress, inflammation, and in-stent restenosis on 6-month follow-up coronary angiogram (20). While these trials were all conducted in patients with acute MI, the benefits of glycemic control may extend to the almost 35% of patients that go on to develop peri-procedural myonecrosis and possibly even more so those with clinically significant peri-procedural MI.…”