RT Journal Article
SR Electronic
T1 Acute hyperglycaemia prevents the protective effect of pre-infarction angina on microvascular function after primary angioplasty for acute myocardial infarction
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1402
OP 1406
DO 10.1136/hrt.2008.142158
VO 94
IS 11
A1 T Takahashi
A1 Y Hiasa
A1 Y Ohara
A1 S Miyazaki
A1 K Mahara
A1 R Ogura
A1 H Miyajima
A1 K Yuba
A1 N Suzuki
A1 S Hosokawa
A1 K Kishi
A1 R Ohtani
YR 2008
UL http://heart.bmj.com/content/94/11/1402.abstract
AB 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 <600 ms. Echocardiographic wall motion was analysed before revascularisation and 4 weeks later.Results: Acute hyperglycaemia, defined as a blood glucose level of ⩾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.