Impact of acute hyperglycemia during primary stent implantation in patients with ST-elevation myocardial infarction
Impact of acute hyperglycemia during primary stent implantation in patients with ST-elevation myocardial infarction
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DOI：
10.1016/j.jjcc.2008.11.011
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发表时间：
2009-04-01
影响因子：
2.5
通讯作者：
Momomura, Shinichi
中科院分区：
文献类型：
--
作者：
Nakamura, Tomohiro;Ako, Junya;Momomura, Shinichi
背景：急性高血糖与急性冠状动脉综合征患者死亡率增加相关。目的：本研究旨在评价ST段抬高型急性心肌梗死（STEMI）患者行直接介入治疗期间血糖水平与临床变量之间的关系。方法和结果：在连续94例接受直接支架植入术的STEMI患者中，有29例患者发生急性高血糖（入院时血糖水平> 198 mg/dl）。除了糖尿病和HbA（1c）水平外，急性高血糖患者和非急性高血糖患者的基线特征无显著差异。在急性高血糖患者中，校正的TIMI帧数显著高于无急性高血糖患者（46.3 ± 30.3 vs. 34.0 ± 17.9，p = 0.02）。校正的TIMI帧计数与血糖水平独立相关（p = 0.006）。急性高血糖患者血清肌酸激酶（CK）和肌酸激酶同工酶（CK-MB）最大值明显升高（CK，4840.0 ± 4690.3 vs. 2410.7 ± 2302.9 IU，p=0.001; CK-MB，315.3 ± 257.7 vs. 195.9 ± 191.1，p=0.01）。急性高血糖的存在与直接支架植入后心外膜冠状动脉血流受损有关。这一机制可能是导致梗死面积增加的原因。(C)2008年日本心脏病学院。由Elsevier爱尔兰有限公司出版。保留所有权利。
Background: Acute hyperglycemia is associated with increased mortality rates in patients with acute coronary syndrome. Objective: This study aimed to evaluate the relationship between the glucose level and clinical variables during primary intervention in patients with ST-elevation acute myocardial infarction (STEMI).Methods and results: Of consecutive 94 patients with STEMI treated by primary stent implantation, acute hyperglycemia (plasma glucose level on admission > 198 mg/dl) was recognized in 29 patients. There were no significant differences in baseline characteristics, except for the presence of diabetes and HbA(1c) level, between patients with and without acute hyperglycemia. In patients with acute hyperglycemia, corrected TIMI frame counts were significantly higher compared with those in patients without acute hyperglycemia (46.3 +/- 30.3 vs. 34.0 +/- 17.9, p = 0.02). And corrected TIMI frame count was independently associated with plasma glucose level (p = 0.006). Maximum level of creatine kinase (CK) and CK-MB were significantly higher in patients with acute hyperglycemia (CK, 4840.0 +/- 4690.3 vs. 2410.7 +/- 2302.9 IU, p=0.001; CK-MB, 315.3 +/- 257.7 vs. 195.9 +/- 191.1, p=0.01).Conclusion: The presence of acute hyperglycemia was associated with the impairment of epicardial coronary flow after primary stent implantation. This mechanism might be responsible for the increased infarct size. (C) 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.