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Pepe M, Addabbo F, Cecere A, Tritto R, Napoli G, Nestola PL, Cirillo P, Biondi-Zoccai G, Giordano S, Ciccone MM. Acute Hyperglycemia-Induced Injury in Myocardial Infarction. Int J Mol Sci 2024; 25:8504. [PMID: 39126075 PMCID: PMC11313474 DOI: 10.3390/ijms25158504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Acute hyperglycemia is a transient increase in plasma glucose level (PGL) frequently observed in patients with ST-elevation myocardial infarction (STEMI). The aim of this review is to clarify the molecular mechanisms whereby acute hyperglycemia impacts coronary flow and myocardial perfusion in patients with acute myocardial infarction (AMI) and to discuss the consequent clinical and prognostic implications. We conducted a comprehensive literature review on the molecular causes of myocardial damage driven by acute hyperglycemia in the context of AMI. The negative impact of high PGL on admission recognizes a multifactorial etiology involving endothelial function, oxidative stress, production of leukocyte adhesion molecules, platelet aggregation, and activation of the coagulation cascade. The current evidence suggests that all these pathophysiological mechanisms compromise myocardial perfusion as a whole and not only in the culprit coronary artery. Acute hyperglycemia on admission, regardless of whether or not in the context of a diabetes mellitus history, could be, thus, identified as a predictor of worse myocardial reperfusion and poorer prognosis in patients with AMI. In order to reduce hyperglycemia-related complications, it seems rational to pursue in these patients an adequate and quick control of PGL, despite the best pharmacological treatment for acute hyperglycemia still remaining a matter of debate.
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Affiliation(s)
- Martino Pepe
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari “Aldo Moro”, 70100 Bari, Italy (M.M.C.)
| | - Francesco Addabbo
- ASL Taranto, Local Health Authority of Taranto, Statistics and Epidemiology Unit, 74100 Taranto, Italy;
| | - Annagrazia Cecere
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy;
| | - Rocco Tritto
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari “Aldo Moro”, 70100 Bari, Italy (M.M.C.)
| | - Gianluigi Napoli
- Division of Cardiology, Villa Verde Clinic, 74121 Taranto, Italy;
| | | | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy;
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
- Maria Cecilia Hospital, GVM Care & Research, 48032 Cotignola, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy;
| | - Marco Matteo Ciccone
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari “Aldo Moro”, 70100 Bari, Italy (M.M.C.)
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Savic L, Mrdovic I, Asanin M, Stankovic S, Lasica R, Krljanac G, Simic D, Matic D. Long-Term Prognostic Impact of Stress Hyperglycemia in Non-Diabetic Patients Treated with Successful Primary Percutaneous Coronary Intervention. J Pers Med 2024; 14:591. [PMID: 38929812 PMCID: PMC11204510 DOI: 10.3390/jpm14060591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/17/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND stress hyperglicemia (SH) is common in patients with ST-elevation myocardial infraction (STEMI). The aims of this study were to analyze the impact of SH on the incidence of all-cause mortality and major adverse cardiovascular events (MACE-cardiovascular death, nonfatal reinfarction, target vessel revascularization, and stroke) in STEMI patients without diabetes mellitus (DM) who have been treated successfully with primary PCI (pPCI). METHOD we analyzed 2362 STEMI patients treated with successful pPCI (post-procedural flow TIMI = 3) and without DM and cardiogenic shock at admission. Stress hyperglycemia was defined as plasma glucose level above 7.8 mmol/L at admission. The follow-up period was 8 years. RESULTS incidence of SH was 26.9%. Eight-year all-cause mortality and MACE rates were significantly higher in patients with SH, as compared to patients without SH (9.7% vs. 4.2%, p < 0.001, and 15.7% vs. 9.4%, p < 0.001). SH was an independent predictor of short- and long-term all-cause mortality (HR 2.19, 95%CI 1.16-4.18, and HR 1.99, 95%CI 1.03-3.85) and MACE (HR 1.49, 95%CI 1.03-2.03, and HR 1.35, 95%CI 1.03-1.89). CONCLUSION despite successful revascularization, SH at admission was an independent predictor of short-term and long-term (up to eight years) all-cause mortality and MACE, but its negative prognostic impact was stronger in short-term follow-up.
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Affiliation(s)
- Lidija Savic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Igor Mrdovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Milika Asanin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Sanja Stankovic
- Emergency Center, Center for Medical Biochemistry, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Ratko Lasica
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Damjan Simic
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Dragan Matic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.M.); (M.A.); (R.L.); (G.K.); (D.M.)
- Emergency Center, Cardiology Intensive Care Unit & Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
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Gursoy E, Baydar O. The triglyceride-glucose index and contrast-induced nephropathy in non-ST elevation myocardial infarction patients undergoing percutaneous coronary intervention. Medicine (Baltimore) 2023; 102:e32629. [PMID: 36637929 PMCID: PMC9839251 DOI: 10.1097/md.0000000000032629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The triglyceride glucose (TyG) index is an indicator of insulin resistance and associated with increased risk of diabetes mellitus and cardiovascular events. Our study investigates the correlation between TyG index and contrast induced nephropathy (CIN) in non-diabetic patients with non-ST elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). 350 non-diabetic NSTEMI patients (183, 52.3% male) undergoing PCI were retrospectively enrolled. The enrolled cohort was divided into 2 groups based on the calculated TyG index, namely values < 8.65 or higher. CIN was defined as an increase in serum creatinine > 25% or 0.5 mg/dL from baseline in the first 48 to 72 hours after PCI. A total of 56 (16%) cases of CIN were diagnosed. In contrast to patients with lower TyG indexes, patients with higher TyG indexes (≥8.65) had a higher frequency of CIN, 9.5%. versus 20.8% respectively (P .004). Patients with CIN also had higher TyG indexes (8.74 ± 0.12 vs 8.67 ± 0.11, P < .001). In addition, TyG index, age, and glomerular filtration rate were identified as independent risk factors for CIN in logistic regression model (OR: 2.5 CI: 1.3-4.6, P .006, OR: 1.0 CI: 1.0-1.1, P < .001, OR: 1.0 KI: 1.03-1.06, P .025). In the ROC analysis, the area under the curve predictive of CIN was 0.666 (P < .001, 95% [CI] 0.58-0.75) with a cutoff value of 8.69 (sensitivity 71,4%, specificity 55.1%) TyG index. Higher TyG indexes are associated with an increased risk of CIN in non-diabetic patients with NSTEMI.
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Affiliation(s)
- Erol Gursoy
- Koc University Hospital, Department of Cardiology, Istanbul, Turkey
- * Correspondence: Erol Gürsoy, Koc University Hospital, Department of Cardiology, Maltepe District, Davutpaşa Street, No:4, Zeytinburnu, Istanbul, Turkey (e-mail: )
| | - Onur Baydar
- Koc University Hospital, Department of Cardiology, Istanbul, Turkey
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Impact of Stress Hyperglycemia on No-Reflow Phenomenon in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Glob Heart 2022; 17:23. [PMID: 35586740 PMCID: PMC8973831 DOI: 10.5334/gh.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Stress hyperglycemia is a common finding during acute myocardial infarction and associated with poor prognosis. To reduce the occurrence of no-reflow, prognostic factors must be identified before primary percutaneous coronary intervention (PPCI). Our objective was to investigate the impact of stress hyperglycemia in non-diabetic and diabetic patients on no-reflow phenomenon after PPCI. Methods: The study comprised 480 patients with ST elevation myocardial infarction (STEMI) who were managed by PPCI. Patients were classified into two groups according to thrombolysis in myocardial infarction (TIMI) flow grade: Group I (Patients with normal flow, TIMI 3 flow) and Group II (Patients with no-reflow, TIMI 0-2 flow). Patients were analyzed for clinical outcomes including mortality and major adverse cardiac events. Results: Incidence of stress hyperglycemia was 14.8% in non-diabetic patients and 22.2% in diabetic patients; the incidence of no-reflow phenomenon was 13.5% and no-reflow was significantly higher in patients with stress hyperglycemia. Multivariate regression analysis identified the independent predictors of no-reflow phenomenon: stress hyperglycemia OR 3.247 (CI95% 1.656–6.368, P = 0.001), Killip class >1 OR 1.893 (CI95% 1.004–3.570, P = 0.049) and cardiogenic shock OR 3.778 (CI95% 1.458–9.790, P = 0.006). Conclusion: Stress hyperglycemia was associated with higher incidence of no-reflow phenomenon. The independent predictors of no-reflow were stress hyperglycemia, Killip class >1 and cardiogenic shock.
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BAYDAR O. The Relationship Between HbA1c and Contrast-Induced Nephropathy in Patients with Non-ST Elevation Myocardial Infarction and Non- Established Diabetes Mellitus. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.882755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kewcharoen J, Yi R, Trongtorsak A, Prasitlumkum N, Mekraksakit P, Vutthikraivit W, Kanjanauthai S. Pre-Procedural Hyperglycemia Increases the Risk of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1377-1385. [PMID: 32402789 DOI: 10.1016/j.carrev.2020.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) frequently occurs following coronary angiography (CAG) and is associated with worse outcomes, including both short and long-term mortality. Previous studies reported an association between procedural hyperglycemia (PH) and CIN, with or without diabetes mellitus (DM). We performed a systematic review and meta-analysis to explore the association of PH and CIN in patients undergoing CAG. METHODS We searched the databases of MEDLINE and EMBASE from inception to January 2020. Included studies investigated CIN incidence in patients undergoing CAG. Data from each study were combined using the random-effects model. RESULTS A total of eight studies were included in this meta-analysis. We found that PH was associated with an increased risk of CIN following CAG (pooled OR = 1.71, 95%CI:1.35-2.16, where PH was defined as ≥140 mg/dl; and pooled OR = 2.07, 95%CI:1.80-2.37, where PH was defined as ≥200 mg/dl). In subgroup analysis of non-diabetic patients and STEMI patients undergoing primary percutaneous coronary intervention, we found that PH was associated with an increased risk of CIN in both subgroups, where PH was defined as ≥140 mg/dl and ≥200mg/dl (p-value < 0.05). CONCLUSIONS Our meta-analysis demonstrated that PH significantly increases the risk of CIN following CAG, in both diabetic and non-diabetic populations. Further studies are needed to evaluate whether strict blood glucose control can reduce the incidence of CIN in this population.
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Affiliation(s)
- Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA.
| | - Ruiyang Yi
- Department of Internal Medicine, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | - Poemlarp Mekraksakit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Somsupha Kanjanauthai
- Division of Cardiovascular Medicine, Keck School of Medicine of University of Southern California, CA, USA
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Acute hyperglycemia and contrast-induced nephropathy in patients with non-ST elevation myocardial infarction. Cardiovasc Endocrinol Metab 2020; 9:24-29. [PMID: 32104788 DOI: 10.1097/xce.0000000000000187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023]
Abstract
Acute hyperglycemia and contrast-induced nephropathy (CIN) are frequently observed in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI), and both are associated with an increased mortality rate. We investigated the possible association between acute hyperglycemia and CIN in patients with NSTEMI undergoing PCI. Materials and methods We retrospectively enrolled 281(149, 53% men) NSTEMI patients undergoing PCI. For each patient, plasma glucose levels were secreened at hospital admission. Acute hyperglycemia was defined as glucose levels > 198 mg/dl. CIN was defined as an increase in serum creatinine 25% or 0.5 mg/dl from baseline in the first 48-72 hours. Results Overall, 44 (15.7%) patients had acute hyperglycemia. Patients with acute hyperglycemia had higher incidence of CIN than those without acute hyperglycemia (29.5 vs 5.1%, P < 0.001). Also, in-hospital mortality, length of hospital stay, major bleeding, requirement of mechanical ventilation and dialysis were observed significantly higher in patients with hyperglycemia. Patients were then reallocated to two groups according to the presence or absence of CIN. Overall, 25 cases (8.9%) of CIN were diagnosed. Diabetes mellitus, weight, age, glucose level and estimated glomerular filtration rate (eGFR) were detected as independent risk factors of CIN. Additionally, admission glucose levels were significantly correlated with creatinine levels after PCI, eGFR and contrast volume/eGFR ratio. Conclusion In NSTEMI patients undergoing primary PCI, acute hyperglycemia may be associated with an increased risk for CIN and in-hospital mortality and morbidity.
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Khalfallah M, Abdelmageed R, Elgendy E, Hafez YM. Incidence, predictors and outcomes of stress hyperglycemia in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Diab Vasc Dis Res 2020; 17:1479164119883983. [PMID: 31726871 PMCID: PMC7510353 DOI: 10.1177/1479164119883983] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Stress hyperglycemia is a common finding during ST elevation myocardial infarction in diabetic patients and is associated with a worse outcome. However, there are limited data about stress hyperglycemia in non-diabetic patients and its outcome especially in patients undergoing primary percutaneous coronary intervention. METHODS The study was conducted on 660 patients with ST elevation myocardial infarction who were managed with primary percutaneous coronary intervention. Patients were classified into two groups according to the presence of stress hyperglycemia: group I (patients with stress hyperglycemia) and group II (patients without stress hyperglycemia). Patients were analysed for clinical outcome including mortality and the occurrence of major adverse cardiac events. RESULTS Incidence of stress hyperglycemia was 16.8%, multivariate regression analysis identified the independent predictors of stress hyperglycemia, that were family history of diabetes mellitus odds ratio 1.697 (95% confidence interval: 1.077-2.674, p = 0.023), body mass index >24 kg/m2 odds ratio 1.906 (95% confidence interval: 1.244-2.922, p = 0.003) and cardiogenic shock on admission odds ratio 2.517 (95% confidence interval: 1.162-5.451, p = 0.019). Mortality, cardiogenic shock, contrast induced nephropathy and no reflow phenomenon were significantly higher in stress hyperglycemia group with p value = 0.027, 0.001, 0.020 and 0.037, respectively. CONCLUSION Stress hyperglycemia in non-diabetic patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with increased incidence of no reflow phenomenon, contrast induced nephropathy, cardiogenic shock and higher mortality.
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Affiliation(s)
- Mohamed Khalfallah
- Department of Cardiovascular Medicine,
Tanta University, Tanta, Egypt
- Mohamed Khalfallah, Department of
Cardiovascular Medicine, Tanta University, 31 Elgeish Street, Tanta 31511,
Egypt.
| | - Randa Abdelmageed
- Department of Cardiovascular Medicine,
Tanta University, Tanta, Egypt
| | - Ehab Elgendy
- Department of Cardiovascular Medicine,
Tanta University, Tanta, Egypt
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Baydar O, Kilic A. CHA2DS2-VASC Score Predicts Risk of Contrast-Induced Nephropathy in Non-ST Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Interventions. KIDNEY DISEASES (BASEL, SWITZERLAND) 2019; 5:266-271. [PMID: 31768384 PMCID: PMC6873045 DOI: 10.1159/000501036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/18/2019] [Indexed: 05/05/2023]
Abstract
BACKROUND The CHA2DS2-VASC score, used for embolic risk stratification in atrial fibrillation, has been reported recently to predict adverse clinical outcomes in patients with coronary artery disease. We investigated the correlation between the CHA2DS2-VASC score and contrast-induced nephropathy (CIN) in patients with non-ST elevation myocardial infarction (NSTEMI) who underwent percutaneous coronary intervention (PCI). METHODS We retrospectively enrolled 363 (191; 52.6% men) NSTEMI patients undergoing PCI. The CHA2 DS2-VASC score was calculated for each patient, and the study population was divided into 2 groups: CHA2DS2-VASC score <2 group (low score; n = 259, 71.3%) and CHA2DS2-VASC score ≥2 group (high score; n = 104, 28.6%). Patients were then reallocated to 2 groups according to the presence or absence of CIN. CIN was defined as a rise in serum creatinine >0.5 mg/dL or >25% increase in baseline within 72 h after PCI. RESULTS Overall, 56 cases (15.4%) of CIN were diagnosed. When patients with a CHA2DS2-VASC score of <2 were compared with those with a CHA2DS2-VASC score of ≥2, patients with a high score had a higher frequency of CIN (33) 31.7% versus (23) 8.9%; p < 0.001. Also patients with CIN had higher CHADS2 VASC score (3.94 ± 1.13 vs. 1.68 ± 0.46, p < 0.001). Additionally, in-hospital mortality, length of hospital stay, major bleeding, requirement of mechanical ventilation, and dialysis were observed significantly higher in patients with CHA2DS2-VASC score of ≥2 (p = 0.001, p = 0.002, p = 0.006, p = 0.001, p = 0.001, respectively). In receiver operating characteristic curve analysis, the area under the curve for predicting CIN was 0.702 (p < 0.001, 95% CI 0.617-0.787) and cutoff value was 2.5 (sensitivity 58.9%, specificity 76.9%) for the number of CHA2DS2-VASC score. CONCLUSION In NSTEMI patients undergoing PCI, CHADS2 VASC score is associated with an increased risk for CIN and in-hospital morbidity and mortality.
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Affiliation(s)
- Onur Baydar
- *Onur Baydar, MD, Department of Cardiology, Koc University Hospital, ZEYTINBURNU, TR–34000 Istanbul (Turkey), E-Mail
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Pepe M, Zanna D, Cafaro A, Marchese A, Addabbo F, Navarese EP, Napodano M, Cecere A, Resta F, Paradies V, Bortone AS, Favale S. Role of plasma glucose level on myocardial perfusion in ST-segment elevation myocardial infarction patients. J Diabetes Complications 2018; 32:764-769. [PMID: 29937139 DOI: 10.1016/j.jdiacomp.2018.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 01/08/2023]
Abstract
AIMS Hyperglycemia is frequent in patients with ST elevation myocardial infarction (STEMI) and is associated with adverse outcome. Aim of our study was to evaluate the correlation between admission plasma glucose level (PGL) and coronary arteries flow velocity. METHODS We enrolled 149 STEMI patients successfully treated with primary percutaneous coronary intervention (pPCI). The study population was divided into two groups based on PGL (< or >140 mg/dl) and on history of diabetes, and the groups compared in terms of corrected TIMI frame count (cTFC). RESULTS Hyperglycemic patients had a significantly higher cTFC in both the culprit (p < 0.0001) and non-culprit vessel (p: 0.0002); diabetes history impairs as well cTFC of the culprit (p < 0.0001) and non-culprit vessel (p: 0.0001). Within the subpopulation of diabetic patients hyperglycemic ones showed higher cTFC in both the culprit (p 0.0013) and non-culprit vessel (p: 0.0006). Moreover in the whole population cTFC values of both arteries increase linearly with the increment of admission PGL. CONCLUSIONS Admission PGL affects coronary flow of both culprit and non-culprit vessel. The impairment of coronary flow is also demonstrated in known diabetic patients, suggesting to consider hyperglycemia an additional risk factor. We finally demonstrated for the first time a positive linear relationship between PGL and cTFC.
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Affiliation(s)
- Martino Pepe
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Domenico Zanna
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Alessandro Cafaro
- Department of Cardiology, General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Alfredo Marchese
- Department of Cardiology, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Francesco Addabbo
- Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Bari, Italy
| | - Eliano Pio Navarese
- Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Massimo Napodano
- Department of Cardiac, Thoracic and Vascular Sciences, Hospital-University of Padova, Padova, Italy
| | - Annagrazia Cecere
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy.
| | - Fabrizio Resta
- Department of Cardiology, "Santa Maria" Hospital, GVM Care & Research, Bari, Italy
| | - Valeria Paradies
- Department of Cardiology, Maasstad Ziekenhuis Hospital, Rotterdam, Netherlands
| | - Alessandro Santo Bortone
- Division of Heart Surgery, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Stefano Favale
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
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Marenzi G, Cosentino N, Milazzo V, De Metrio M, Rubino M, Campodonico J, Moltrasio M, Marana I, Grazi M, Lauri G, Bonomi A, Barbieri S, Assanelli E, Dalla Cia A, Manfrini R, Ceriani R, Bartorelli A. Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia. J Am Heart Assoc 2018; 7:JAHA.117.008122. [PMID: 29654205 PMCID: PMC6015410 DOI: 10.1161/jaha.117.008122] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background In acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia. Methods and Results At admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c (%)−46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA−C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; P=0.02 for trend) and ΔA−C (13%, 13%, 23%; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55–0.69]; P=0.001) and ΔA−C (area under the curve: 0.62 [95% confidence interval, 0.54–0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA−C to acute glycemia allowed proper AKI risk prediction in 16% of patients. Conclusions In diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.
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Affiliation(s)
| | | | | | | | - Mara Rubino
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | - Marco Grazi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | - Antonio Bartorelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
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Lin KY, Shang XL, Guo YS, Zhu PL, Wu ZY, Jiang H, Ruan JM, Zheng WP, You ZB, Lin CJ. Association of Preprocedural Hyperglycemia With Contrast-Induced Acute Kidney Injury and Poor Outcomes After Emergency Percutaneous Coronary Intervention. Angiology 2018; 69:770-778. [PMID: 29463106 DOI: 10.1177/0003319718758140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We investigated whether preprocedural hyperglycemia was associated with contrast-induced acute kidney injury (CI-AKI) and long-term outcomes in patients with acute coronary syndrome (ACS) who underwent emergency percutaneous coronary intervention (PCI). Patients (n = 558) with ACS who underwent emergency PCI were consecutively enrolled. Preprocedural hyperglycemia was defined as glucose levels >198 mg/dL (11 mmol/L). The primary outcome was CI-AKI (≥0.3 mg/dL absolute or ≥50% relative serum creatinine increase 48 hours after contrast medium exposure). Overall, 103 (18.5%) patients had preprocedural hyperglycemia and 89 (15.9%) patients developed CI-AKI. The incidence of CI-AKI was significantly higher in patients with hyperglycemia than without (28.2% vs 13.2%; P < .01). Multivariate analysis indicated that preprocedural hyperglycemia was an independent predictor of CI-AKI (odds ratio = 1.971, 95% confidence interval [CI]: 1.129-3.441; P < .05). In addition, preprocedural hyperglycemia was associated with an increased risk of all-cause mortality during the 2-year follow-up (hazard ratio = 2.440, 95% CI: 1.394-4.273; P = .002). Preprocedural hyperglycemia is a significant and independent predictor of CI-AKI and long-term outcomes.
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Affiliation(s)
- Kai-Yang Lin
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China.,2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Xiu-Ling Shang
- 3 Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Yan-Song Guo
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Peng-Li Zhu
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Zhi-Yong Wu
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Hui Jiang
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China
| | - Jing-Ming Ruan
- 1 Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fujian Medical University, Fuzhou, China.,2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Wei-Ping Zheng
- 2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Zhe-Bin You
- 2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
| | - Chun-Jin Lin
- 2 Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Institute of Clinical Geriatrics, Fujian Key Laboratory of Geriatrics, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, China
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Wang R, Mei B, Liao X, Lu X, Yan L, Lin M, Zhong Y, Chen Y, You T. Determination of risk factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention. BMC Cardiovasc Disord 2017; 17:243. [PMID: 28899364 PMCID: PMC5596504 DOI: 10.1186/s12872-017-0660-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To determine the factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to establish its prognostic discriminant model. METHODS A total of 701 consecutive STEMI patients undergoing PCI were enrolled in this study. The patients were divided into two groups, good prognosis and poor prognosis, based on whether the patient had adverse outcomes (death or heart function ≥ grade III) at discharge. Demographic and basic clinical characteristics, diagnosis at admission (e.g., ventricular function, complications, or hyperlipidemia), and biomedical indicators (e.g., blood count, basal metabolism and biochemical composition, blood lipid and glucose levels, myocardial biomarkers, and coagulation) were collected and analyzed. RESULTS We determined 22 factors as risk factors for the in-hospital prognosis of STEMI patients after PCI: age, cardiac function during hospitalization, complications, history of diabetes mellitus, et al., among which the history of diabetes, uric acid, urea nitrogen, and activated partial thromboplastin time (APTT) were independent risk factors. CONCLUSION We identified four independent risk factors for the in-hospital prognosis of STEMI patients after PCI and generated a prognostic model to predict the adverse outcomes of these patients.
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Affiliation(s)
- Rui Wang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Biqi Mei
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Xinlong Liao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Xia Lu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Lulu Yan
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Man Lin
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Yao Zhong
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Yili Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 China
| | - Tianhui You
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
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14
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Park SH, Jeong MH, Park IH, Choi JS, Rhee JA, Kim IS, Kim MC, Cho JY, Sim DS, Hong YJ, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Effects of combination therapy of statin and N-acetylcysteine for the prevention of contrast–induced nephropathy in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Int J Cardiol 2016; 212:100-6. [DOI: 10.1016/j.ijcard.2016.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/23/2016] [Accepted: 03/12/2016] [Indexed: 11/26/2022]
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15
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Ujueta F, Weiss EN, Sedlis SP, Shah B. Glycemic Control in Coronary Revascularization. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:12. [PMID: 26820983 DOI: 10.1007/s11936-015-0434-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OPINION STATEMENT Hyperglycemia in the setting of coronary revascularization is associated with increased adverse cardiovascular events in patients with or without diabetes mellitus. Data suggest that acute peri-procedural hyperglycemia causes an increase in inflammation, platelet activity, and endothelial dysfunction and is associated with plaque instability and infarct size. While peri-procedural blood glucose level is an independent predictor of adverse outcomes in patients undergoing coronary revascularization, treatment strategies remain uncertain. Randomized clinical trials of glucose-insulin-potassium infusions have consistently shown no benefit, while those comparing insulin therapy versus standard of care have demonstrated mixed results, likely due to the failure to reach euglycemia with these strategies. Although no glucose-lowering agent has been shown to be superior in peri-procedural glycemic control, the continuation of clinically prescribed long-acting glucose-lowering medications in patients with diabetes mellitus prior to coronary angiography and possible percutaneous coronary intervention may be the simplest and most effective approach to maintain euglycemia and decrease the associated increase in inflammation and platelet activity. However, alternative strategies such as therapies targeted at the underlying mechanism of harm (e.g., more potent anti-platelet therapy, anti-inflammatory therapy) should also be considered and warrant further investigation.
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Affiliation(s)
- Francisco Ujueta
- VA New York Harbor Healthcare System, Manhattan Campus, New York, NY, USA.,New York University School of Medicine, New York, NY, 10016, USA
| | - Ephraim N Weiss
- VA New York Harbor Healthcare System, Manhattan Campus, New York, NY, USA.,New York University School of Medicine, New York, NY, 10016, USA
| | - Steven P Sedlis
- VA New York Harbor Healthcare System, Manhattan Campus, New York, NY, USA.,New York University School of Medicine, New York, NY, 10016, USA
| | - Binita Shah
- VA New York Harbor Healthcare System, Manhattan Campus, New York, NY, USA. .,New York University School of Medicine, New York, NY, 10016, USA.
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16
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Eshraghi A, Talasaz AH, Salamzadeh J, Bahremand M, Salarifar M, Nozari Y, Jenab Y, Boroumand MA, Vaseghi G, Eshraghi N. Study of the possible medical and medication explanatory factors of angiographic outcomes in patients with acute ST elevation myocardial infarction undergoing primary percutaneous intervention. Adv Biomed Res 2014; 3:186. [PMID: 25250300 PMCID: PMC4166209 DOI: 10.4103/2277-9175.140096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/08/2013] [Indexed: 11/04/2022] Open
Abstract
Background: Myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) and corrected TIMI frame count (cTFC) are indices of successful angiographic reperfusion. This study sought to determine the predictors of angiographically successful reperfusion including demographic, clinical and angiographic factors in patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Materials and Methods: A cross-sectional study of patients with a confirmed diagnosis of STEMI undergoing pPCI was designed. Eligible patients referring to a university heart center were enrolled in the study from March 2012 to December 2012. Successful epicardial reperfusion was defned as TIMI flow grade 3 or cTFC<= 28 frames and successful myocardial reperfusion as MBG 2 or 3. Results: The study population consisted of 100 patients, including 74 males and 26 females, with mean ± standard deviation age of 58.27 ± 11.60 years. Achieving open microvasculature (MBG 2/3) was positively associated with a history of nitrate intake (P = 0.03) and history of calcium channel blocker (CCB) intake (P = 0.005). Hyperglycemia was inversely associated with achieving a final cTFC ≤ 28 frames (r = −0.32, P = 0.001). Conclusions: Our findings suggest that patients with a history of nitrate and CCB intake had a higher likelihood of successful PCI. In addition, patients with a higher blood glucose level on admission may have a reduced rate of reperfusion success. Future studies with a larger sample size are recommended to investigate the significant relationships observed in this study.
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Affiliation(s)
- Azadeh Eshraghi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti, University of Medical Sciences, Tehran, Iran ; Students Research Committee, Shahid Beheshti, University of Medical Sciences, Tehran, Iran
| | - Azita Hajhossein Talasaz
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran ; Department of cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Salamzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti, University of Medical Sciences, Tehran, Iran
| | | | - Mojtaba Salarifar
- Department of cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yones Nozari
- Department of cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yaser Jenab
- Department of cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Boroumand
- Department of cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Golnaz Vaseghi
- Department of pharmacology, Applid Physiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazanin Eshraghi
- Department of Radiology, Tabriz University of Medical Science, Tabriz, Iran
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17
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Akyuz S, Kemaloglu Oz T, Altay S, Karaca M, Yaylak B, Gungor B, Yazici S, Erdogan G, Nurkalem Z, Kasikcioglu H. Association between Glycosylated Haemoglobin Level and Contrast-Induced Acute Kidney Injury in Patients with Type 2 Diabetes Mellitus. Cardiorenal Med 2014; 4:95-102. [PMID: 25254031 DOI: 10.1159/000362569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/26/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There are several reports suggesting that admission hyperglycaemia increases the risk of contrast-induced acute kidney injury (CI-AKI). However, it is not clear whether there has been an association between long-standing poor glycaemic control and the incidence of CI-AKI. The purpose of this study was to examine the impact of poor glycaemic control or elevated glycosylated haemoglobin (HbA1c) on the incidence of CI-AKI in patients with type 2 diabetes mellitus (T2DM). METHODS The present study prospectively enrolled 133 patients with T2DM undergoing elective coronary angiography (CAG) and/or intervention. All patients had an estimated glomerular filtration rate (eGFR) of ≥60 ml/min/1.73 m(2). Patients were divided into two groups: those with an optimal HbA1c (<7%) and those with an elevated HbA1c (≥7%). All had similar baseline characteristics and were hydrated appropriately. The outcome was assessed by the incidence of CI-AKI. RESULTS CI-AKI occurred in 2 of 41 patients (4.9%) with optimal HbA1c levels and 5 of 92 patients (5.4%) with elevated HbA1c levels (p = 0.89). The cutoff point of HbA1c was set at 6.5%, but no statistically significant difference between the two groups was observed [1 of 24 patients (4.1%) vs. 6 of 109 patients (5.5%), p = 0.79]. However, despite a high variability in the incidence of CI-AKI, there was no statistically significant difference between the two groups when varying CI-AKI definitions were considered. CONCLUSION An elevated HbA1c level is not associated with a higher incidence of CI-AKI compared to optimal HbA1c levels in patients with T2DM (patients with an eGFR of ≥60 ml/min/1.73 m(2)) undergoing CAG and/or intervention.
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Affiliation(s)
- Sukru Akyuz
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Ordu, Turkey
| | - Tugba Kemaloglu Oz
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Ordu, Turkey
| | - Servet Altay
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Ordu, Turkey
| | - Mehmet Karaca
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Ordu, Turkey
| | - Baris Yaylak
- Department of Cardiology, Diyarbakır Training and Research Hospital, Diyarbakır, Ordu, Turkey
| | - Baris Gungor
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Ordu, Turkey
| | - Selcuk Yazici
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Ordu, Turkey
| | - Guney Erdogan
- Department of Cardiology, Fatsa State Hospital, Ordu, Turkey
| | - Zekeriya Nurkalem
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Ordu, Turkey
| | - Hulya Kasikcioglu
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Ordu, Turkey
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18
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Chen P, Chua S, Hung H, Huang C, Lin C, Lai S, Chen Y, Cheng J, Chiu C, Lee S, Lo H, Shyu K. Admission hyperglycemia predicts poorer short- and long-term outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction. J Diabetes Investig 2014; 5:80-6. [PMID: 24843741 PMCID: PMC4025238 DOI: 10.1111/jdi.12113] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 04/26/2013] [Accepted: 05/07/2013] [Indexed: 01/08/2023] Open
Abstract
AIMS/INTRODUCTION Admission hyperglycemia is associated with poor outcome in patients with myocardial infarction. The present study evaluated the relationship between admission glucose level and other clinical variables in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS The 959 consecutive STEMI patients undergoing primary PCI were divided into five groups based on admission glucose levels of <100, 100-139, 140-189, 190-249 and ≥250 mg/dL. Their short- and long-term outcomes were compared. RESULTS Higher admission glucose levels were associated with significantly higher in-hospital morbidity and mortality, the overall mortality rate at follow up, and the incidence of reinfarction or heart failure requiring admission or leading to mortality at follow up. The odds ratios (95% confidence interval) for in-hospital morbidity, in-hospital mortality, mortality at follow up and re-infarction or heart failure or mortality at follow up of patients with admission glucose levels ≥190 mg/dL, compared with those with admission glucose levels <190 mg/dL, were 2.12 (1.3-3.4, P = 0.001), 2.74 (1.4-5.5, P = 0.004), 2.52 (1.2-5.1, P = 0.01) and 1.70 (1.03-2.8, P = 0.04), respectively. Previously non-diabetic patients with admission glucose levels ≥250 mg/dL had significantly higher in-hospital morbidity or mortality (44 vs 70%, P = 0.03). Known diabetic patients had higher rates of reinfarction, heart failure or mortality at follow up in the 100-139 mg/dL (8 vs 27%, P = 0.04) and 140-189 mg/dL (11 vs 26%, P = 0.02) groups. CONCLUSIONS Admission hyperglycemia, especially at glucose levels ≥190 mg/dL, is a predictor of poor prognosis in STEMI patients undergoing primary PCI.
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Affiliation(s)
- Pei‐Chi Chen
- Division of Endocrinology and MetabolismShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Su‐Kiat Chua
- Graduate Institute of Clinical MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
- Division of CardiologyShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
- Department of General MedicineShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Huei‐Fong Hung
- Division of CardiologyShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Chung‐Yen Huang
- Division of Endocrinology and MetabolismShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Chiu‐Mei Lin
- Department of Emergency MedicineShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
- Institute of BiotechnologyNational Ilan UniversityIlanTaiwan
- Institute of Injury Prevention and ControlCollege of Public HealthTaipei Medical UniversityTaipeiTaiwan
| | - Shih‐Ming Lai
- Division of Endocrinology and MetabolismShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Yen‐Ling Chen
- Division of Endocrinology and MetabolismShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Jun‐Jack Cheng
- Division of CardiologyShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Chiung‐Zuan Chiu
- Division of CardiologyShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Shih‐Huang Lee
- Division of CardiologyShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Huey‐Ming Lo
- Division of CardiologyShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
| | - Kou‐Gi Shyu
- Graduate Institute of Clinical MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
- Division of CardiologyShin Kong Wu Ho‐Su Memorial HospitalTaipeiTaiwan
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19
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Lee MG, Jeong MH, Lee KH, Park KH, Sim DS, Yoon HJ, Yoon NS, Kim KH, Park HW, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Prognostic impact of diabetes mellitus and hypertension for mid-term outcome of patients with acute myocardial infarction who underwent percutaneous coronary intervention. J Cardiol 2012; 60:257-63. [DOI: 10.1016/j.jjcc.2012.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/19/2012] [Accepted: 06/06/2012] [Indexed: 12/20/2022]
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20
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Sarazawa K, Nakano A, Uzui H, Mitsuke Y, Geshi T, Okazawa H, Ueda T, Lee JD. Acute hyperglycemia causes microvascular damage, leading to poor functional recovery and remodeling in patients with reperfused ST-segment elevation myocardial infarction. J Nucl Cardiol 2012; 19:507-14. [PMID: 22314555 DOI: 10.1007/s12350-012-9525-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 01/22/2012] [Indexed: 10/14/2022]
Abstract
BACKGROUND Although acute hyperglycemia (AHG) is associated with poor outcomes in ST-segment elevation myocardial infarction (STEMI) patients, underlying mechanisms have not been fully elucidated. We investigated the influence of AHG on myocardial microcirculation in reperfused STEMI patients. METHODS AND RESULTS Thirty-four STEMI patients were divided into 2 groups according to the presence (Group H, n 5 11) or the absence (Group L, n 5 23) of AHG. Myocardial blood flow (MBF) and myocardial flow reserve (MFR) in the infarct-related area were compared between 2 groups, using ¹³N-ammonia positron emission tomography. Wall motion abnormality scores (WMASs) and end-diastolic volume indices (EDVI) were also assessed at 1 and 6 months after the onset. Although resting MBF was similar, MFR was lower in Group H than in Group L (1.69 ± 0.37 vs 2.39 ± 0.56, P = .001). WMAS was greater in Group H than in Group L at both 1 month (7.4 ± 3.7 vs 3.7 ± 3.0, P = .011) and 6 months (7.3 ± 3.9 vs 3.1 ± 3.4, P = .015). EDVI tended to be greater in Group H than in Group L at 6 months (103.8 ± 42.9 vs 73.9 ± 16.0 mL/m2, P = .071). Multivariate analysis showed AHG to be independently associated with low MFR. CONCLUSIONS In STEMI patients, AHG impaired myocardial microcirculation, leading to poor functional recovery and remodeling despite successful reperfusion.
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Affiliation(s)
- Katsuhiko Sarazawa
- First Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Fukui, Japan
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Yildiz A, Arat-Ozkan A, Kocas C, Abaci O, Coskun U, Bostan C, Olcay A, Akturk F, Okcun B, Ersanli M, Gurmen T. Admission Hyperglycemia and TIMI Frame Count in Primary Percutaneous Coronary Intervention. Angiology 2011; 63:325-9. [DOI: 10.1177/0003319711418957] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ahmet Yildiz
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Alev Arat-Ozkan
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Cuneyt Kocas
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Okay Abaci
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Ugur Coskun
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Cem Bostan
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Ayhan Olcay
- Department of Cardiology, 29 Mayis Private Hospital, Istanbul, Turkey
| | - Faruk Akturk
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Baris Okcun
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Murat Ersanli
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
| | - Tevfik Gurmen
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
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22
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Marenzi G, De Metrio M, Rubino M, Lauri G, Cavallero A, Assanelli E, Grazi M, Moltrasio M, Marana I, Campodonico J, Discacciati A, Veglia F, Bartorelli AL. Acute hyperglycemia and contrast-induced nephropathy in primary percutaneous coronary intervention. Am Heart J 2010; 160:1170-7. [PMID: 21146674 DOI: 10.1016/j.ahj.2010.09.022] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 09/26/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute hyperglycemia and contrast-induced nephropathy (CIN) are frequently observed in ST-elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), and both are associated with an increased mortality rate. We investigated the possible association between acute hyperglycemia and CIN in patients undergoing primary PCI. METHODS We prospectively enrolled 780 STEMI patients undergoing primary PCI. For each patient, plasma glucose levels were assessed at hospital admission. Acute hyperglycemia was defined as glucose levels>198 mg/dL (11 mmol/L). Contrast-induced nephropathy was defined as an increase in serum creatinine>25% from baseline in the first 72 hours. RESULTS Overall, 148 (19%) patients had acute hyperglycemia; and 113 (14.5%) patients developed CIN. Patients with acute hyperglycemia had a 2-fold higher incidence of CIN than those without acute hyperglycemia (27% vs 12%, P<.001). In-hospital mortality was higher in patients with acute hyperglycemia than in those without acute hyperglycemia (12% vs 3%, P<.001). Mortality rate was also higher in patients developing CIN than in those without this renal complication (27% vs 0.9%, P<.001). Patients with acute hyperglycemia that developed CIN had the highest mortality rate (38%). Acute hyperglycemia was an independent predictor of CIN and in-hospital mortality. CONCLUSIONS In STEMI patients undergoing primary PCI, acute hyperglycemia is associated with an increased risk for CIN and with increased in-hospital mortality.
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23
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Honda T, Kanazawa H, Koga H, Miyao Y, Fujimoto K. Heart rate on admission is an independent risk factor for poor cardiac function and in-hospital death after acute myocardial infarction. J Cardiol 2010; 56:197-203. [DOI: 10.1016/j.jjcc.2010.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/06/2010] [Accepted: 05/10/2010] [Indexed: 12/19/2022]
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Lemkes BA, Hermanides J, Devries JH, Holleman F, Meijers JCM, Hoekstra JBL. Hyperglycemia: a prothrombotic factor? J Thromb Haemost 2010; 8:1663-9. [PMID: 20492456 DOI: 10.1111/j.1538-7836.2010.03910.x] [Citation(s) in RCA: 192] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetes mellitus is characterized by a high risk of atherothrombotic events. What is more, venous thrombosis has also been found to occur more frequently in this patient group. This prothrombotic condition in diabetes is underpinned by laboratory findings of elevated coagulation factors and impaired fibrinolysis. Hyperglycemia plays an important role in the development of these hemostatic abnormalities, as is illustrated by the association with glycemic control and the improvement upon treatment of hyperglycemia. Interestingly, stress induced hyperglycemia, which is often transient, has also been associated with poor outcome in thrombotic disease. Similar laboratory findings suggest a common effect of acute vs. chronic hyperglycemia on the coagulation system. Many mechanisms have been proposed to explain this prothrombotic shift in hyperglycemia, such as a direct effect on gene transcription of coagulation factors caused by hyperglycemia-induced oxidative stress, loss of the endothelial glycocalyx layer, which harbours coagulation factors, and direct glycation of coagulation factors, altering their activity. In addition, both chronic and acute hyperglycemia are often accompanied by hyperinsulinemia, which has been shown to have prothrombotic effects as well. In conclusion, the laboratory evidence of the effects of both chronic and acute hyperglycemia suggests a prothrombotic shift. Additionally, hyperglycemia is associated with poor clinical outcome of thrombotic events. Whether intensive treatment of hyperglycemia can prevent hypercoagulability and improve clinical outcome remains to be investigated.
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Affiliation(s)
- B A Lemkes
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, the Netherlands.
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A prospective observational study of the relationship of critical illness associated hyperglycaemia in medical ICU patients and subsequent development of type 2 diabetes. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R130. [PMID: 20615210 PMCID: PMC2945097 DOI: 10.1186/cc9101] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 04/30/2010] [Accepted: 07/08/2010] [Indexed: 12/16/2022]
Abstract
Introduction Critical illness is commonly complicated by hyperglycaemia caused by mediators of stress and inflammation. Severity of disease is the main risk factor for development of hyperglycaemia, but not all severely ill develop hyperglycemia and some do even in mild disease. We hypothesised that acute disease only exposes a latent disturbance of glucose metabolism which puts those patients at higher risk for developing diabetes. Methods Medical patients with no history of impaired glucose metabolism or other endocrine disorder admitted to an intensive care unit between July 1998 and June 2004 were considered for inclusion. Glucose was measured at least two times a day, and patients were divided into the hyperglycaemia group (glucose ≥7.8 mmol/l) and normoglycaemia group. An oral glucose tolerance test was performed within six weeks after discharge to disclose patients with unknown diabetes or pre-diabetes who were excluded. Patients treated with corticosteroids and those terminally ill were also excluded from the follow-up which lasted for a minimum of five years with annual oral glucose tolerance tests. Results A five-year follow-up was completed for 398 patients in the normoglycaemia group, of which 14 (3.5%) developed type 2 diabetes. In the hyperglycaemia group 193 patients finished follow-up and 33 (17.1%) developed type 2 diabetes. The relative risk for type 2 diabetes during five years after the acute illness was 5.6 (95% confidence interval (CI) 3.1 to 10.2). Conclusions Patients with hyperglycaemia during acute illness who are not diagnosed with diabetes before or during the hospitalization should be considered a population at increased risk for developing diabetes. They should, therefore, be followed-up, in order to be timely diagnosed and treated.
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Hyperglycemia in sepsis is a risk factor for development of type II diabetes. J Crit Care 2010; 25:263-9. [DOI: 10.1016/j.jcrc.2009.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 09/03/2009] [Accepted: 10/01/2009] [Indexed: 11/22/2022]
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Shiraishi J, Kohno Y, Sawada T, Takeda M, Arihara M, Hyogo M, Shima T, Okada T, Nakamura T, Matoba S, Yamada H, Matsumuro A, Shirayama T, Kitamura M, Furukawa K, Matsubara H. Influence of previous myocardial infarction site on in-hospital outcome after primary percutaneous coronary intervention for repeat myocardial infarction. J Cardiol 2010; 55:77-83. [DOI: 10.1016/j.jjcc.2009.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 08/09/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022]
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Glucose–insulin–potassium infusion in the management of acute hyperglycemia in patients with ST-segment elevation acute myocardial infarction: Lessons learned from randomized trials. J Cardiol 2009; 54:167-8; author reply 168. [DOI: 10.1016/j.jjcc.2009.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 02/23/2009] [Indexed: 11/17/2022]
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