CLINICAL RESEARCH: MYOCARDIAL INFARCTION
Hyperglycemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarction
Jorik R. Timmer, MD*,
Jan Paul Ottervanger, MD, PhD*,
Menko-Jan de Boer, MD, PhD, FACC*,
Jan-Henk E. Dambrink, MD, PhD*,
Jan C.A. Hoorntje, MD, PhD*,
A.T. Marcel Gosselink, MD, PhD*,
Harry Suryapranata, MD, PhD*,
Felix Zijlstra, MD, PhD, FACC ,
Arnoud W.J. van't Hof, MD, PhD*,* Zwolle Myocardial Infarction Study Group
* Department of Cardiology, Isala Klinieken, locatie Weezenlanden, Zwolle, the Netherlands
Department of Cardiology, Thoraxcenter, University Hospital Groningen, Groningen, the Netherlands
Manuscript received October 27, 2004;
revised manuscript received December 2, 2004,
accepted December 13, 2004.
* Reprint requests and correspondence: Dr. Arnoud W. J. van't Hof, Department of Cardiology, Isala Klinieken, locatie Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands
(Email: v.r.c.derks{at}isala.nl).
OBJECTIVES: This study was designed to investigate whether elevated glucose is associated with impaired Thrombolysis In Myocardial Infarction (TIMI) flow before primary percutaneous coronary intervention (PCI).
BACKGROUND: Reperfusion before primary PCI in patients with ST-segment elevation myocardial infarction (STEMI) is associated with an improved outcome. Hyperglycemia in patients with STEMI is associated with an adverse prognosis. Hyperglycemia may induce a pro-thrombotic state and therefore be of influence on TIMI flow before PCI.
METHODS: A total of 460 consecutive patients with STEMI treated with primary PCI were included in this analysis. Hyperglycemia was defined as a glucose  7.8 mmol/l (140 mg/dl).
RESULTS: Hyperglycemia was observed in 70% and TIMI flow grade 3 before primary PCI in 17% of the patients. Patients with hyperglycemia less often had TIMI flow grade 3 before primary PCI (12% vs. 28%, p < 0.001). After adjustment for differences in baseline variables, hyperglycemia was a strong predictor of absence of reperfusion before primary PCI (odds ratio 2.6, 95% confidence interval 1.5 to 4.5).
CONCLUSIONS: Hyperglycemia in patients with STEMI is an important predictor of impaired epicardial flow before reperfusion therapy has been initiated. Investigation of methods improving coronary flow before primary PCI in these patients is warranted.
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Abbreviations and Acronyms
| | OR = odds ratio | | PCI = percutaneous coronary intervention | | STEMI = ST-segment elevation myocardial infarction | | TIMI = Thrombolysis In Myocardial Infarction |
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