CLINICAL STUDY: MYOCARDIAL INFARCTION AND ACUTE CORONARY SYNDROME
Association between hyperglycemia and the no-reflow phenomenon inpatients with acute myocardial infarction
Katsuomi Iwakura, MD*,
Hiroshi Ito, MD, FACC*,*,
Masashi Ikushima, MD*,
Shigeo Kawano, MD*,
Atsushi Okamura, MD*,
Katsuaki Asano, MD*,
Tadashi Kuroda, MD*,
Koji Tanaka, MD*,
Tohru Masuyama, MD ,
Masatsugu Hori, MD and
Kenshi Fujii, MD*
* Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka University, Osaka, Japan
Department of Internal Medicine and Therapeutics, Graduate School of Medicine, Osaka University, Osaka, Japan
Manuscript received August 13, 2002;
revised manuscript received September 12, 2002,
accepted September 20, 2002.
* Reprint requests and correspondence: Dr. Hiroshi Ito, Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
itomd{at}osk4.3web.ne.jp
OBJECTIVES: We investigated the association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction (AMI).
BACKGROUND: Hyperglycemia is associated with increased risks of heart failure, cardiogenic shock, and death after AMI, but its underlying mechanism remains unknown.
METHODS: A total of 146 consecutive patients with a first AMI were studied by intracoronary myocardial contrast echocardiography (MCE) after successful reperfusion within 24 h after symptom onset. Two-dimensional echocardiography was recorded on day 1 and three months later to determine the change in the wall motion score ( WMS; sum of 16 segmental scores; dyskinesia = 4 to normokinesia = 0).
RESULTS: The no-reflow phenomenon was found on MCE in 49 (33.6%) of 146 patients; their glucose level on hospital admission was significantly higher than that of patients who did not exhibit this phenomenon (209 ± 79 vs. 159 ± 56 mg/dl; p < 0.0001). There was no difference in glycosylated hemoglobin or in the incidence of diabetes mellitus between the two subsets. The no-reflow phenomenon was more often observed in the 75 patients with hyperglycemia ( 160 mg/dl) than in those without hyperglycemia (52.0% vs. 14.1%; p < 0.0001). Patients with hyperglycemia had a higher peak creatine kinase level (2,497 ± 1,603 vs. 1,804 ± 1,300 IU/l; p = 0.005) and a lower WMS (3.7 ± 4.8 vs. 5.7 ± 4.3; p = 0.01) than did those without hyperglycemia. The blood glucose level was an independent prognostic factor for no reflow, along with age, gender, absence of pre-infarction angina, complete occlusion of the culprit lesion, and anterior AMI.
CONCLUSIONS: Hyperglycemia might be associated with impaired microvascular function after AMI, resulting in a larger infarct size and worse functional recovery.
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Abbreviations and Acronyms
| | AMI | | acute myocardial infraction | | CK | | creatine kinase | | DM | | diabetes mellitus | | ECG | | electrocardiogram or electrocardiographic | | HbA1c | | glycosylated hemoglobin | | MCE | | myocardial contrast echocardiography | | PCI | | percutaneous coronary intervention | | TIMI | | Thrombolysis In Myocardial Infarction | | WMS | | wall motion score |
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P. Dandona, A. Chaudhuri, H. Ghanim, and P. Mohanty
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53(5 Suppl):
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|
|
|
|
|
|
|
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60(1):
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|
|
|
|
|
|
|
M. Kosiborod
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5(4):
269 - 275.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T Takahashi, Y Hiasa, Y Ohara, S Miyazaki, K Mahara, R Ogura, H Miyajima, K Yuba, N Suzuki, S Hosokawa, et al.
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94(11):
1402 - 1406.
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|
|
|
|
|
|
|
Q.-h. Tuo, H. Zeng, A. Stinnett, H. Yu, J. L. Aschner, D.-F. Liao, and J.-X. Chen
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Am J Physiol Heart Circ Physiol,
June 1, 2008;
294(6):
H2547 - H2557.
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[Full Text]
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|
|
|
|
|
|
|
A. Chaudhuri, R. Nesto, and P. Dandona
Glucose-Insulin-Potassium Therapy in Patients With STEMI
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May 28, 2008;
299(20):
2386 - 2387.
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|
|
|
|
|
|
|
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March 25, 2008;
117(12):
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[Full Text]
[PDF]
|
|
|
|
|
|
|
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117(8):
1018 - 1027.
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|
|
|
|
|
|
|
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92(6):
2136 - 2140.
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|
|
|
|
|
|
|
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Circulation,
May 8, 2007;
115(18):
e436 - e439.
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|
|
|
|
|
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|
C. Bauters, P. V. Ennezat, O. Tricot, B. Lauwerier, R. Lallemant, H. Saadouni, P. Quandalle, O. Jaboureck, N. Lamblin, T. Le Tourneau, et al.
Stress hyperglycaemia is an independent predictor of left ventricular remodelling after first anterior myocardial infarction in non-diabetic patients
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March 1, 2007;
28(5):
546 - 552.
[Abstract]
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[PDF]
|
|
|
|
|
|
|
Z Kadri, N Danchin, L Vaur, Y Cottin, P Gueret, M Zeller, J-M Lablanche, D Blanchard, G Hanania, N Genes, et al.
Major impact of admission glycaemia on 30 day and one year mortality in non-diabetic patients admitted for myocardial infarction: results from the nationwide French USIC 2000 study
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July 1, 2006;
92(7):
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|
|
|
|
|
|
|
J.-P. Collet and G. Montalescot
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Diabetes and Vascular Disease Research,
October 1, 2005;
2(3):
136 - 143.
[Abstract]
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|
|
|
|
|
|
|
M. Kosiborod, S. S. Rathore, S. E. Inzucchi, F. A. Masoudi, Y. Wang, E. P. Havranek, and H. M. Krumholz
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111(23):
3078 - 3086.
[Abstract]
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|
|
|
|
|
|
|
G. Ertl and S. Frantz
Healing after myocardial infarction
Cardiovasc Res,
April 1, 2005;
66(1):
22 - 32.
[Abstract]
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|
|
|
|
|
|
|
T. M Conner, K. R Flesner-Gurley, and J. C Barner
Hyperglycemia in the Hospital Setting: The Case for Improved Control Among Non-Diabetics
Ann. Pharmacother.,
March 1, 2005;
39(3):
492 - 501.
[Abstract]
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|
|
|
|
|
|
|
A. Ceriello
Acute hyperglycaemia: a 'new' risk factor during myocardial infarction
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26(4):
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|
|
|
|
|
|
|
D. Aguilar, S. D. Solomon, L. Kober, J.-L. Rouleau, H. Skali, J. J.V. McMurray, G. S. Francis, M. Henis, C. M. O'Connor, R. Diaz, et al.
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110(12):
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|
|
|
|
|
|
|
C. M. Cely, P. Arora, A. A. Quartin, D. H. Kett, and R. M. H. Schein
Relationship of Baseline Glucose Homeostasis to Hyperglycemia During Medical Critical Illness
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September 1, 2004;
126(3):
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|
|
|
|
|
|
|
Z. T. Bloomgarden
Inpatient Diabetes Control: Approaches to treatment
Diabetes Care,
September 1, 2004;
27(9):
2272 - 2277.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-K. Yip, C.-J. Wu, C.-H. Yang, H.-W. Chang, S.-M. Chen, W.-C. Hung, and C.-L. Hang
Delayed Post-Myocardial Infarction Invasive Measures, Helpful or Harmful?: A Subgroup Analysis
Chest,
July 1, 2004;
126(1):
38 - 46.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. L. Lazar, S. R. Chipkin, C. A. Fitzgerald, Y. Bao, H. Cabral, and C. S. Apstein
Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events
Circulation,
March 30, 2004;
109(12):
1497 - 1502.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L Galiuto
Optimal therapeutic strategies in the setting of post-infarct no reflow: the need for a pathogenetic classification
Heart,
February 1, 2004;
90(2):
123 - 125.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Kaul and H. Ito
Microvasculature in Acute Myocardial Ischemia: Part II: Evolving Concepts in Pathophysiology, Diagnosis, and Treatment
Circulation,
January 27, 2004;
109(3):
310 - 315.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. H. Mehta, K. J. Harjai, D. Cox, G. W. Stone, B. Brodie, J. Boura, W. O'Neill, C. L. Grines, and Primary Angioplasty in Myocardial Infarction (PAMI
Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention
J. Am. Coll. Cardiol.,
November 19, 2003;
42(10):
1739 - 1746.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Ito and K. Yamamoto
Prognostic significance of coronary blood flow velocity patterns in patients with reperfused acute myocardial infarction and TIMI-2 flow: Reply
J. Am. Coll. Cardiol.,
July 2, 2003;
42(1):
182 - 183.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Zijlstra, I. C. C. van der Horst, A. W. J. van't Hof, and H. J. G. Bilo
Hyperglycemia and no-reflow phenomenon in acute myocardial infarction
J. Am. Coll. Cardiol.,
June 18, 2003;
41(12):
2300 - 2300.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Dandona, A. Aljada, A. Chaudhuri, and A. Bandyopadhyay
The Potential Influence of Inflammation and Insulin Resistance on the Pathogenesis and Treatment of Atherosclerosis-Related Complications in Type 2 Diabetes
J. Clin. Endocrinol. Metab.,
June 1, 2003;
88(6):
2422 - 2429.
[Full Text]
[PDF]
|
|
|
|
