Acute hyperglycaemia prevents the protective effect of pre-infarction angina on microvascular function after primary angioplasty for acute myocardial infarction
| Autor: | Koichi Kishi, Takefumi Takahashi, Shinobu Hosokawa, Yoshikazu Ohara, Riyo Ogura, Kenichiro Yuba, Keitaro Mahara, Naoki Suzuki, Hitoshi Miyajima, Shinichiro Miyazaki, Yoshikazu Hiasa, Ryuji Ohtani |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Diastole Infarction Coronary Angiography Angina Coronary circulation Coronary Circulation Internal medicine Angioplasty medicine Humans Myocardial infarction Angioplasty Balloon Coronary Microvascular Angina Interventional cardiology business.industry Microcirculation Coronary flow reserve Middle Aged Prognosis medicine.disease medicine.anatomical_structure Echocardiography Hyperglycemia Cardiology Female Cardiology and Cardiovascular Medicine business Blood Flow Velocity |
| Zdroj: | Heart. 94:1402-1406 |
| ISSN: | 1355-6037 |
| Popis: | Acute hyperglycaemia has been associated with impaired microvascular function after acute myocardial infarction (AMI), whereas pre-infarction angina (PIA) occurring shortly before the onset of AMI has been shown to reduce microvascular injury after reperfusion.To examine whether acute hyperglycaemia prevents the protective effect of PIA on microvascular function after AMI.We studied 205 patients with a first anterior wall AMI who underwent primary angioplasty within 12 hours of onset. Coronary flow velocity parameters were assessed immediately after reperfusion using a Doppler guidewire. Severe microvascular injury was defined as the presence of systolic flow reversal and diastolic deceleration time600 ms. Echocardiographic wall motion was analysed before revascularisation and 4 weeks later.Acute hyperglycaemia, defined as a blood glucose level ofor=198 mg/dl on admission, was found in 67 (33%) patients. In patients without acute hyperglycaemia, PIA was associated with a lower incidence of systolic flow reversal, a longer diastolic deceleration time and a higher coronary flow reserve. However, in patients with acute hyperglycaemia there was no significant difference in these same parameters between patients with and without PIA. In the presence of acute hyperglycaemia PIA did not improve the change in wall motion score. In a multivariate model, the absence of PIA was an independent determinant of severe microvascular injury in patients without acute hyperglycaemia (odds ratio 6.28, p = 0.001), but not in patients with acute hyperglycaemia.The protective effect of PIA on microvascular function was attenuated in patients with acute hyperglycaemia, resulting in unfavourable functional recovery. |
| Databáze: | OpenAIRE |
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