Key result
Hyperglycemia in STEMI is linked to ~2.6-fold higher odds of absent reperfusion before primary PCI.
Why the study?
Hyperglycemia in patients with STEMI is associated with adverse prognosis and may influence TIMI flow before primary PCI, but its association with impaired coronary flow before reperfusion therapy was unclear.
Does hyperglycemia predict impaired TIMI flow before primary PCI in patients with STEMI?
Observational (n=460)
Does hyperglycemia predict impaired TIMI flow before primary PCI in patients with STEMI?
Odds Ratio: 2.6 (95% CI 1.5–4.5)
Absolute Event Rate: 12% vs 28%
p-value: p=<0.001
Hyperglycemia in STEMI patients is a strong independent predictor of impaired epicardial flow prior to primary PCI, suggesting a pro-thrombotic state.
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 > or =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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Timmer et al. (2005) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=460). Hyperglycemia (glucose ≥7.8 mmol/l) vs. Normoglycemia was evaluated on TIMI flow grade 3 before primary PCI (absence of reperfusion for OR) (OR 2.6, 95% CI 1.5-4.5, p=<0.001). Hyperglycemia in STEMI patients strongly predicted the absence of reperfusion before primary PCI (OR 2.6; 95% CI 1.5-4.5), with TIMI flow grade 3 seen in 12% vs 28% of patients (p<0.001).
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