Comparison of Myocardial Reperfusion in Patients With Fasting Blood Glucose ≤100, 101 to 125, and >125 mg/dl and ST-Elevation Myocardial Infarction With Percutaneous Coronary Intervention

• Published in: The American journal of cardiology 2008-12, Vol.102 (11), p.1457-1462
• Main Authors: Fefer, Paul, MD, Hod, Hanoch, MD, Ilany, Jacob, MD, Shechter, Michael, MD, Segev, Amit, MD, Novikov, Ilia, PhD, Guetta, Victor, MD, Matetzky, Shlomi, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Blood Glucose - metabolism; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Clinical outcomes; Comparative studies; Coronary heart disease; Diabetes; Diseases of the cardiovascular system; Fasting; Female; Glucose; Heart; Heart attacks; Heart Conduction System - physiopathology; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial Reperfusion; Myocarditis. Cardiomyopathies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stroke Volume; Survival Analysis; Ventricular Function, Left; Young Adult
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.07.031

Diabetes and impaired fasting glucose (FG) were associated with worse outcomes in patients with acute myocardial infarction (MI). Because the underlying mechanism is not entirely clear, 376 consecutive patients with ST-elevation MI who underwent primary percutaneous coronary intervention (PPCI) were investigated. Patients were divided into 3 groups based on FG ≤100, FG of 101 to 125, and FG >125 mg/dl or previously diagnosed diabetes mellitus (DM) and studied for electrocardiographic signs of myocardial reperfusion (both spontaneous and after PPCI) and clinical outcomes. Clinical reperfusion was less likely with increasing FG: FG ≤100 mg/dl, 26%; FG of 101 to 125, 19%; and FG >125 and/or DM, 16% (p for trend = 0.03). Accordingly, angiographic TIMI grade 3 flow on initial angiography was 22% for FG ≤100 mg/dl, 13% for FG of 101 to 125, and 14% for FG >125 and/or DM (p for trend = 0.05). Despite similar TIMI flow after PPCI, early ST-segment resolution (≥70%) was noted in 76%, 63%, and 60% in patients with FG ≤100 mg/dl, FG of 101 to 125, and FG >125 and/or DM, respectively (p for trend