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Major stress-related metabolic changes occur in the first hours after ST-segment elevation myocardial infarction (STEMI), leading to glucose intolerance in some patients
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Elevated glucose levels and glucose intolerance are associated with an increased risk of mortality, heart failure and cardiogenic shock and no-reflow phenomenon in the culprit vessel
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Elevated admission glucose levels in the setting of STEMI are associated with impaired microvascular function in non-culprit vessels at baseline
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Larger STEMI’s with higher Troponin T levels are associated with higher glucose levels, which may be associated with microvascular dysfunction in non-culprit vessels
Introduction
Methods
Cardiac catheterisation and periprocedural measurements
Haemodynamic data analysis
Statistical analysis
Demographics | |
Age, y | 56 ± 12 |
Male | 74 (80) |
Risk factors | |
Smoking | 49 (53) |
Hypertension | 23 (25) |
Family history | 39 (42) |
Hyperlipidaemia | 24 (26) |
Prior medication use | |
β‑Blocker | 12 (13) |
Calcium antagonist | 8 (9) |
Angiotensin-converting enzyme inhibitors | 5 (5) |
Nitrates | 4 (4) |
Lipid-lowering drugs | 7 (8) |
Aspirin | 11 (12) |
Laboratory assessment at admission | |
CRP, mg/l | 1.9 [1.1–5.2] |
Glucose, mmol/l | 8.3 [7.2–9.6] |
Creatinine, µmol/l | 70 [60–79] |
NT-proBNP after reperfusion, pg/ml | 93 [49–242] |
Peak troponin T after 24 hours, ng/ml | 4.58 [2.47–6.34] |
Procedural characteristics | |
Heart rate, bpm | 79 ± 13 |
Systolic arterial pressure, mm Hg | 119 ± 15 |
WMSI before reperfusion | 1.9 ± 0.2 |
Time to reperfusion, h | 2.9 [2.3–3.9] |
ST-segment resolution after reperfusion ≥70% | 40 (43) |
Angiographic | |
Final TIMI flow grade 3 | 56 (60) |
Final myocardial blush grade 3 | 37 (40) |
Results
Infarct-related artery at admission (n =92) | |
Final IRA CFVR | 1.5 [1.3–1.7] |
– Baseline APV, cm per second | 19 [14–24] |
– Hyperaemic APV, cm per second | 29 [21–42] |
Infarct-related artery at 1 week (n =62) | |
Final IRA CFVR | 1.9 [1.6–2.2] |
– Baseline APV, cm per second | 21 ± 7 |
– Hyperaemic APV, cm per second | 37 [30–44] |
Infarct-related artery at 6 months (n =61) | |
Final IRA CFVR | 2.8 ± 0.9 |
– Baseline APV, cm per second | 17 ± 7 |
– Hyperaemic APV, cm per second | 48 ± 19 |
Reference vessel haemodynamics at admission (n =91) | |
Reference CFVR | 2.3 [2.0–2.7] |
– Baseline APV, cm per second | 16 [14–20] |
– Hyperaemic APV, cm per second | 37 [31–45] |
Baseline MR, mm Hg/cm per second | 7.2 [6.2–8.8] |
Hyperaemic MR, mm Hg/cm per second | 3.1 [2.6–3.8] |
Delta MR, mm Hg/cm per second | 4.0 [3.3–5.4] |
Reference vessel haemodynamics at 1 week (n =62) | |
Reference CFVR | 2.7 ± 0.5 |
– Baseline APV, cm per second | 17 [13–20] |
– Hyperaemic APV, cm per second | 44 [35–53] |
Baseline MR, mm Hg/cm per second | 6.6 [5.4–8.4] |
Hyperaemic MR, mm Hg/cm per second | 2.5 [2.1–3.0] |
Delta MR, mm Hg/cm per second | 4.2 [3.4–5.4] |
Reference vessel haemodynamics at 6 months (n =61) | |
Reference CFVR | 3.4 ± 0.6 |
– Baseline APV, cm per second | 15 [10–21] |
– Hyperaemic APV, cm per second | 47 [39–60] |
Baseline MR, mm Hg/cm per second | 8.9 [6.2–11.3] |
Hyperaemic MR, mm Hg/cm per second | 2.5 [2.0–3.0] |
Delta MR, mm Hg/cm per second | 6.0 [4.1–8.3] |
Association between admission glucose and microvascular function after PPCI
At admission (n = 92) | At 1‑week follow-up (n = 61) | At 6‑month follow-up (n = 61) | ||||||
---|---|---|---|---|---|---|---|---|
Univariable analysis | Multivariable analysis | Multivariable analysis | Multivariable analysis | |||||
Std beta | P value | Std beta | P value | Std beta | P value | Std beta | P value | |
CFVR in reference vessel | ||||||||
Glucose | −0.381 | <0.001 | −0.313 | 0.002 | – | – | – | – |
Age | −0.254 | 0.015 | – | – | – | – | – | – |
Heart rate | −0.225 | 0.034 | – | – | −0.413 | 0.002 | – | – |
Peak troponin T (after 24 h) | −0.469 | <0.001 | −0.355 | 0.002 | – | – | – | – |
WMSI | −0.265 | 0.014 | – | – | – | – | −0.278 | 0.042 |
Calcium antagonist | −0.381 | <0.001 | – | – | – | – | – | – |
Baseline APV in reference vessel | ||||||||
Glucose | 0.244 | 0.02 | 0.216 | 0.033 | – | – | – | – |
Age | – | – | – | – | – | – | – | – |
Heart rate | – | – | – | – | – | – | – | – |
Peak troponin T (after 24 h) | 0.241 | 0.026 | – | – | – | – | – | – |
WMSI | 0.316 | 0.003 | 0.266 | 0.014 | – | – | – | – |
Calcium antagonist | 0.349 | 0.001 | 0.385 | <0.001 | – | – | – | – |
Baseline MR in reference vessel | ||||||||
Glucose | −0.257 | 0.015 | −0.225 | 0.038 | – | – | – | – |
Age | – | – | – | – | – | – | – | – |
Heart rate | −0.262 | 0.02 | −0.229 | 0.045 | −0.269 | 0.044 | – | – |
Peak troponin T (after 24 h) | −0.228 | 0.038 | – | – | −0.346 | 0.022 | – | – |
WMSI | −0.326 | 0.003 | −0.246 | 0.035 | – | – | – | – |
Calcium antagonist | −0.295 | 0.006 | −0.292 | 0.008 | – | – | – | – |
Delta MR in reference vessel | ||||||||
Glucose | −0.325 | 0.002 | −0.274 | 0.008 | – | – | – | – |
Age | – | – | – | – | – | – | – | – |
Heart rate | −0.318 | 0.004 | −0.244 | 0.023 | −0.320 | 0.015 | – | – |
Peak troponin T (after 24 h) | −0.376 | <0.001 | – | – | −0.336 | 0.022 | – | – |
WMSI | −0.357 | 0.001 | −0.223 | 0.041 | – | – | – | – |
Calcium antagonist | −0.299 | 0.005 | −0.247 | 0.016 | – | – | – | – |