Hyperglycemia on admission was associated with a significantly higher incidence of the no-reflow phenomenon compared to patients without hyperglycemia (52.0% vs. 14.1%; p<0.0001).
Cohort (n=146)
Does admission hyperglycemia increase the risk of the no-reflow phenomenon in patients with acute myocardial infarction?
Admission hyperglycemia in patients with acute myocardial infarction is independently associated with the no-reflow phenomenon, larger infarct size, and worse functional recovery.
Absolute Event Rate: 52% vs 14.1%
p-value: p=<0.0001
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 (DeltaWMS; 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 /=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 DeltaWMS (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.
Iwakura et al. (Mon,) conducted a cohort in acute myocardial infarction (n=146). Hyperglycemia (≥160 mg/dl) vs. Without hyperglycemia was evaluated on No-reflow phenomenon on intracoronary myocardial contrast echocardiography (p=<0.0001). Hyperglycemia on admission was associated with a significantly higher incidence of the no-reflow phenomenon compared to patients without hyperglycemia (52.0% vs. 14.1%; p<0.0001).