Hyperglycemia and intramyocardial hemorrhage in patients with ST-segment elevation myocardial infarction
Hyperglycemia and intramyocardial hemorrhage in patients with ST-segment elevation myocardial infarction
复制标题
ST段抬高型心肌梗死患者高血糖与心肌内出血
DOI：
10.1016/j.jjcc.2022.06.003
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发表时间：
2022
影响因子：
2.5
通讯作者：
Tanaka A
中科院分区：
文献类型：
--
作者：
Ota S;Nishiguchi T;Taruya A;Tanimoto T;Ino Y;Katayama Y;Ozaki Y;Satogami K;Tanaka A
背景ST段抬高型心肌梗死（STEMI）患者入院时高血压和心肌内出血（IMH）与预后不良相关。关于入院时血糖水平与IMH之间的关系知之甚少。基质金属蛋白酶-9（MMP-9）在IMH的发展中起重要作用，与高血糖之间的关联也是未知的。本研究旨在探讨STEMI患者入院时高血糖与IMH之间的关系。MethodsWe纳入了174例首次STEMI患者，他们接受了直接经皮冠状动脉介入治疗（PCI）和心血管磁共振（CMR）成像。T2加权成像和晚期钆增强（LGE）-CMR分别用于检测IMH和微血管阻塞（MVO）。分为两组：IMH组和非IMH组。结果IMH组入院时血糖水平和糖化血红蛋白值均高于非IMH组[IMH组vs. non-IMH组; 208.5（157.8-300.5）mg/dL对比157.0（128.8-204.3）mg/dL，p< 0.001，和6.2（5.7-7.5）%对比5.8（5.4-6.6）%，p= 0.030]。多因素Logistic回归分析显示，只有入院时血糖水平是IMH的独立预测因素（OR：1.012，95%CI：1.005- 1.020，p = 0.001）。IMH患者的MMP-9水平高于非IMH患者[256.0（161.0-396.0）ng/mL vs. 73.5（49.5-131.0）ng/mL，p= 0.040]。入院时血糖水平与MMP-9水平呈中度正相关（r = 0.600，p = 0.030）。
BackgroundHyperglycemia at admission and intramyocardial hemorrhage (IMH) are associated with poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Little is known about the relationship between glucose levels at admission and IMH. The association between matrix metalloproteinase-9 (MMP-9), which plays an important role in the development of IMH, and hyperglycemia is also unknown. This study aimed to investigate the relationship between hyperglycemia at admission and IMH in patients with STEMI.MethodsWe enrolled 174 patients with first STEMI who underwent primary percutaneous coronary intervention (PCI) and cardiovascular magnetic resonance (CMR) imaging. T2-weighted imaging and late gadolinium enhancement (LGE)-CMR were performed to detect IMH and microvascular obstruction (MVO), respectively. Two patient groups were created: IMH group and non-IMH group. MMP-9 levels were measured in the culprit coronary arteries of 13 patients.ResultsGlucose level at admission and the value of glycosylated hemoglobin were higher in the IMH group than in the non-IMH group [IMH group vs. non-IMH group; 208.5 (157.8–300.5) mg/dL vs. 157.0 (128.8–204.3) mg/dL,p< 0.001, and 6.2 (5.7–7.5) % vs. 5.8 (5.4–6.6) %,p= 0.030, respectively]. A multivariable logistic regression analysis revealed that only admission glucose level was an independent predictor of IMH (OR: 1.012; 95 % CI: 1.005–1.020,p= 0.001). The MMP-9 levels in patients with IMH were higher than those in patients without IMH [256.0 (161.0–396.0) ng/mL vs. 73.5 (49.5–131.0) ng/mL,p= 0.040]. There was a moderate positive correlation between glucose levels at admission and MMP-9 levels (r = 0.600,p= 0.030).ConclusionsHyperglycemia at admission is associated with the occurrence of IMH in patients with STEMI.