Acute hyperglycaemia prevents the protective effect of pre-infarction angina on microvascular function after primary angioplasty for acute myocardial infarction
Acute hyperglycaemia prevents the protective effect of pre-infarction angina on microvascular function after primary angioplasty for acute myocardial infarction
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DOI：
10.1136/hrt.2008.142158
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发表时间：
2008-11-01
期刊：
影响因子：
5.7
通讯作者：
Ohtani, R.
中科院分区：
文献类型：
--
作者：
Takahashi, T.;Hiasa, Y.;Ohtani, R.
背景资料：急性高血压与急性心肌梗死（AMI）后微血管功能受损有关，而AMI发作前不久发生的梗死前心绞痛（PIA）已被证明可减轻再灌注后微血管损伤。目的：研究急性高血压是否阻止PIA对AMI后微血管功能的保护作用。我们研究了205例首次前壁AMI患者，他们在发病12小时内接受了直接血管成形术。再灌注后立即使用多普勒导丝评估冠状动脉血流速度参数。67例（33%）患者出现严重微血管损伤，定义为入院时存在收缩期血流逆转和舒张期减速时间= 198 mg/dl。在无急性高血压的患者中，PIA与较低的收缩期血流逆转发生率、较长的舒张期减速时间和较高的冠状动脉血流储备相关。然而，在急性高血压患者中，这些相同的参数在有和没有PIA的患者之间没有显著差异。在急性高血压的存在下，PIA并没有改善室壁运动评分的变化。在一个多变量模型中，没有PIA是一个独立的决定因素，严重的微血管损伤的患者没有急性高血压（比值比6.28，p = 0.001），但不是在患者急性hyperglycemia.Conclusion：PIA对微血管功能的保护作用减弱急性hyperglycemia患者，导致不利的功能恢复。
Background: 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.Objective: To examine whether acute hyperglycaemia prevents the protective effect of PIA on microvascular function after AMI.Methods: 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 time = 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.Conclusion: The protective effect of PIA on microvascular function was attenuated in patients with acute hyperglycaemia, resulting in unfavourable functional recovery.