Effect of primary percutaneous coronary intervention on stress hyperglycaemia in myocardial infarction
A K McGregor1, N Leech, I F Purcell
1Cardiothoracic Services, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK. andrew.mcgregor@gmail.com
Insights
Primary percutaneous coronary intervention significantly lowers blood glucose in ST-segment elevation myocardial infarction patients. This effect is most pronounced in those with hyperglycemia, potentially avoiding insulin treatment.
Area of Science:
- Cardiology
- Endocrinology
- Internal Medicine
Background:
- ST-segment elevation myocardial infarction (STEMI) frequently induces stress hyperglycemia.
- Hyperglycemia in STEMI is associated with adverse outcomes.
- The impact of primary percutaneous coronary intervention (PCI) on this stress hyperglycemia is not fully understood.
Purpose of the Study:
- To evaluate the effect of primary PCI on stress hyperglycemia in STEMI patients.
- To determine if PCI influences blood glucose levels post-myocardial infarction.
Main Methods:
- Blood glucose levels were measured before and 1 hour after primary PCI in STEMI patients.
- A paired t-test was used for statistical analysis.
- Patients were stratified based on pre-intervention glucose levels.
Main Results:
- Overall blood glucose decreased significantly after primary PCI (8.4 to 7.9 mmol/l, P=0.003).
- In hyperglycemic patients (glucose >10 mmol/l), glucose levels dropped markedly post-PCI (12.7 to 9.8 mmol/l, P=0.0002).
- 11.1% of hyperglycemic patients' glucose levels fell below 10 mmol/l after PCI.
Conclusions:
- Primary PCI effectively reduces blood glucose levels in STEMI patients.
- The glucose-lowering effect is most significant in patients with pronounced hyperglycemia.
- Post-PCI glucose measurements may guide insulin therapy decisions, potentially avoiding unnecessary treatment.
Aim:
To measure the effect of primary percutaneous coronary intervention on stress hyperglycaemia induced by ST segment elevation myocardial infarction.
Methods:
We measured blood glucose before primary percutaneous coronary intervention and 1 h after intervention in all patients presenting with ST segment elevation myocardial infarction for 2 months in our unit. A paired t-test was used for a statistical analysis.
Results:
From 157 patients accepted for primary percutaneous coronary intervention, 90 patients were included in the analysis. Blood glucose before intervention was 8.4 ± 2.46 mmol/l (mean ± SD) and after intervention was 7.9 ± 2.0 mmol/l (mean ± sd) (P = 0.003). In the subset of 15 patients with hyperglycaemia (glucose greater than 10 mmol/l), glucose before intervention was 12.7 ± 2.62 mmol/l (mean ± SD) and after intervention was 9.8 ± 3.42 mmol/l (mean ± sd) (P = 0.0002).
Conclusions:
Blood glucose in patients with ST segment elevation myocardial infarction is significantly lower after primary percutaneous coronary intervention and this reduction is most marked in patients with hyperglycaemia. Waiting for the stress response to diminish means that 11.1% of patients' glucose levels fell below the treatment threshold of 10 mmol/l. Using the post-intervention blood glucose level avoids the need for treatment with insulin in this population. Further randomized studies are warranted to investigate the impact on mortality and morbidity of administering insulin triggered by pre-invention blood glucose vs. post-intervention blood glucose.
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