Higher insulin resistance was independently associated with greater left ventricular dilation (adjusted mean difference 1.93 mm for highest vs lowest HOMA-IR tertile) 12 months after STEMI in non-diabetic patients.
Cohort (n=485)
No
Are insulin resistance and dysglycemia associated with left ventricular remodeling after myocardial infarction in non-diabetic patients?
In non-diabetic patients with STEMI, insulin resistance and dysglycemia are prevalent and independently predict adverse post-infarction left ventricular dilation.
Mean Difference: 1.926 (95% CI 1.237–2.614)
Absolute Event Rate: 1.44% vs 0.52%
p-value: p=<0.001
BACKGROUND: Adverse cardiac remodeling after ST-segment elevation myocardial infarction (STEMI) is a major cause for poor cardiovascular outcomes such as heart failure. The predisposing factors and underlying mechanisms remain not fully understood. This study investigates the association of insulin resistance and dysglycemia with left ventricular (LV) remodeling after STEMI in non-diabetic patients. METHODS: A total of 485 non-diabetic subjects with STEMI who underwent primary percutaneous coronary intervention were consecutively enrolled and followed up for 12 months. Relation of homeostasis model assessment-estimated insulin resistance (HOMA-IR) and glucose levels to changes in echocardiography parameters was studied. RESULTS: Left ventricular dilation was detected in 49.1% of subjects at 12-month follow-up after STEMI, and was more severe in subjects with impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and high HOMA-IR levels. HOMA-IR remained correlated to changes in LV dimensions after adjusting for confounding risk factors. Multivariate regression analysis demonstrated that higher HOMA-IR was independently associated with greater LV dilation after STEMI. A significant interaction term was present between HOMA-IR and IGT in the model (P = 0.001). CONCLUSIONS: Our study reveals that insulin resistance and dysglycemia are prevalent in non-diabetic patients with STEMI and are predictors of the post-infarction LV dilation. Trial registration Trials number, NCT02089360; registered on March 17, 2014.
Yang et al. (Wed,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=485). Insulin resistance (HOMA-IR) vs. Low insulin resistance (lowest HOMA-IR tertile) was evaluated on Change in left ventricular end-diastolic diameter (LVEDD) (Coefficient 1.926, 95% CI 1.237-2.614, p=<0.001). Higher insulin resistance was independently associated with greater left ventricular dilation (adjusted mean difference 1.93 mm for highest vs lowest HOMA-IR tertile) 12 months after STEMI in non-diabetic patients.