Peri-procedural tight glycemic control during early percutaneous coronary intervention up-regulates endothelial progenitor cell level and differentiation during acute ST-elevation myocardial infarction: Effects on myocardial salvage

• Published in: International journal of cardiology 2013-10, Vol.168 (4), p.3954-3962
• Main Authors: Marfella, Raffaele, Rizzo, Maria Rosaria, Siniscalchi, Mario, Paolisso, Pasquale, Barbieri, Michelangela, Sardu, Celestino, Savinelli, Antonella, Angelico, Nicola, Del Gaudio, Salvatore, Esposito, Nicolino, Rambaldi, Pier Francesco, D'Onofrio, Nunzia, Mansi, Luigi, Mauro, Ciro, Paolisso, Giuseppe, Balestrieri, Maria Luisa
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Blood Glucose - metabolism; Cardiology. Vascular system; Cardiovascular; Cell Differentiation - physiology; Cell differentiation, maturation, development, hematopoiesis; Cell physiology; Cells, Cultured; Coronary heart disease; Diseases of the cardiovascular system; Endothelial Cells - metabolism; Endothelial progenitor cells; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Glycemic Index - physiology; Heart; Humans; Male; Medical sciences; Middle Aged; Molecular and cellular biology; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - surgery; Myocarditis. Cardiomyopathies; Myocardium - metabolism; Myocardium - pathology; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Preoperative Care - methods; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Salvage Therapy - methods; SIRT1; Stem Cells - metabolism; Time Factors; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2013.06.053

Abstract Background We examined the effects of peri-procedural intensive glycemic control during early percutaneous coronary intervention (PCI) on the number and differentiation of endothelial progenitor cells (EPCs) and myocardial salvage (MS) in hyperglycemic patients with first ST-elevation myocardial infarction (STEMI). Methods and results We conducted a randomized, prospective, open label study on 194 patients with STEMI undergoing PCI: 88 normoglycemic patients (glucose < 140 mg/dl) served as the control group. Hyperglycemic patients (glucose ≥ 140 mg/dl) were randomized to intensive glycemic control (IGC) for almost 24 h after PCI (n = 54; 80–140 mg/dl) or conventional glycemic control (CGC, n = 52; 180–200 mg/dl). EPC number, differentiation, and SIRT1expression were assessed immediately before, 24 h, 7, 30 and 180 days after PCI. The primary end point of the study was salvage index, measured as the proportion of initial perfusion defect (acute technetium-99m sestamibi scintigraphy, performed 5 to 7 days after STEMI) and myocardium salvaged by therapy (6 months after STEMI). Hyperglycemic patients had lower EPC number and differentiation and lower SIRT1 levels than normoglycemic patients (P < 0.01). After the insulin infusion, mean plasma glucose during peri-procedural period was greater in CGC group than in IGC group (P < 0.001). The EPC number, their capability to differentiate, and SIRT1 levels were significantly higher in IGC group than in CGC, peaking after 24 h (P < 0.01). In the IGC group, the salvage index was greater than in patients treated with CGC (P < 0.001). Conclusions Optimal peri-procedural glycemic control, by increasing EPC number and their capability to differentiate, may improve the myocardial salvage.