[The effect of admission hyperglycemia on coronary reflow in primary percutaneous coronary intervention]
Chang-Hua Wang1, Yun-Dai Chen, Xin-Chun Yang
1Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.
Insights
High admission plasma glucose (APG) levels are linked to no-reflow during percutaneous coronary intervention for ST-elevation myocardial infarction. An APG greater than 13.0 mmol/L independently predicts no-reflow, impacting treatment outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Interventional Cardiology
Context:
- ST-elevation acute myocardial infarction (STEMI) is a critical condition requiring timely reperfusion.
- No-reflow phenomenon, a complication of primary percutaneous coronary intervention (PCI), impairs myocardial salvage and worsens prognosis.
- Admission plasma glucose (APG) is a readily available biomarker that may reflect underlying metabolic disturbances and inflammation in STEMI patients.
Purpose:
- To investigate the association between admission plasma glucose (APG) and the incidence of no-reflow during primary PCI in STEMI patients.
- To identify APG as an independent predictor of no-reflow in this patient population.
Summary:
- A study of 1413 STEMI patients undergoing primary PCI found that 21.0% experienced no-reflow.
- Patients in the no-reflow group had significantly higher APG levels compared to those with normal reflow (13.80 ± 7.47 vs. 9.67 ± 5.79 mmol/L, P < 0.0001).
- Multivariate analysis identified APG > 13.0 mmol/L as an independent predictor of no-reflow (OR 1.269, 95%CI 1.156 - 1.402, P = 0.027), alongside factors like current smoking, hyperlipidemia, long reperfusion time, reduced creatinine clearance, and IABP use.
Impact:
- Elevated APG levels, particularly > 13.0 mmol/L, are associated with an increased risk of no-reflow after primary PCI in STEMI.
- These findings highlight the importance of glycemic control and APG monitoring in optimizing outcomes for STEMI patients undergoing PCI.
- Identifying high-risk patients based on APG may allow for targeted interventions to mitigate the no-reflow phenomenon.
Objective:
To assess the association between admission plasma glucose (APG) and no-reflow during primary percutaneous coronary intervention (PCI) in patients with ST-elevation acute myocardial infarction (STEMI).
Methods:
A total of 1413 patients with STEMI successfully treated with PCI were divided into no-reflow group and normal reflow group.
Results:
The no-reflow was found in 297 patients (21.0%) of 1413 patients; their APG level was significantly higher than that of the normal reflow group [(13.80 ± 7.47) vs (9.67 ± 5.79) mmol/L, P < 0.0001]. Multivariate logistic regression analysis revealed that current smoking (OR 1.146, 95%CI 1.026 - 1.839, P = 0.031), hyperlipidemia (OR 1.082, 95%CI 1.007 - 1.162, P = 0.032), long reperfusion (> 6 h, OR 1.271, 95%CI 1.158 - 1.403, P = 0.001), admission creatinine clearance (< 90 ml/min, OR 1.046, 95%CI 1.007 - 1.086, P = 0.020), IABP use before PCI (OR 9.346, 95%CI 1.314 - 67.199, P = 0.026), and APG (> 13.0 mmol/L, OR 1.269, 95%CI 1.156 - 1.402, P = 0.027) were the independent no-reflow predictors. The no-reflow incidence was increased as APG increased (14.6% in patients with APG < 7.8 mmol/L and 36.7% in patients with APG > 13.0 mmol/L, P = 0.009).
Conclusion:
APG > 13.0 mmol/L is an independent no-reflow predictor in patients with STEMI and PPCI.
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