open access

Vol 76, No 3 (2018)
Original articles
Early publication date: 2017-12-15
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Higher admission glycaemia independently of diagnosed or unrecognised diabetes mellitus is a risk factor for failed myocardial tissue reperfusion and higher mortality after primary angioplasty

Łukasz Kalińczuk1, Kamil Zieliński1, Jerzy Pręgowski1, Jakub Przyłuski1, Maciej Karcz1, Paweł Bekta1, Michał Ciszewski1, Zofia Dzielińska1, Adam Witkowski1, Marcin Demkow1
DOI: 10.5603/KP.a2017.0258
·
Kardiol Pol 2018;76(3):594-601.
Affiliations
  1. Instytut Kardiologii

open access

Vol 76, No 3 (2018)
Original articles
Early publication date: 2017-12-15

Abstract

Background and aim: Admission hyperglycaemia worsens reperfusion in ST-segment elevation myocardial infarction (STEMI). ST-segment elevation resolution parallels myocardial tissue reperfusion and predicts the outcome of primary percutaneous coronary intervention (pPCI).

Methods: We investigated whether higher glycaemia on admission impairs tissue-level reperfusion after pPCI for STEMI, as­sessed with the single-lead Schröder method of ST-segment resolution analysis (maxSTE).

Results: Among 323 patients (60.4 ± 11.5 years, 27.8% female), 13.4% of nondiabetic subjects and 58.2% of those with known diabetic history (17%) were admitted with glycaemia > 11.1 mmol/L. Failed tissue reperfusion, recognised if high-risk maxSTE criteria were fulfilled, was present among 25% of patients. The overall 180-day mortality rate was 6.8% (n = 22). Admission glycaemia ≥ 8.75 mmol/L appeared as the single risk factor for failed tissue reperfusion (ROC area = 0.638, standard error = 0.038, p < 0.001). Even after adjustment for diabetes history, patients with admission glycaemia ≥ 8.75 mmol/L (44.5%) had 2.36-fold higher risk (95% confidence interval [CI] 1.25–4.46, p = 0.008) of failed tissue reperfusion. After exclusion of patients with known diabetes and those with acute blood glucose level > 11.1 mmol/L (28%), admission glycaemia remained an independent predictor of failed tissue reperfusion (odds ratio [OR] 1.32, 95% CI 1.03–1.69, p = 0.028). Admission glycae­mia and failed tissue reperfusion (high- vs. low-risk maxSTE category) were the independent predictors of 180-day mortality (OR 1.18, 95% CI 1.05–1.32, p = 0.004 and OR 3.84, 95% CI 1.12–13.21, p = 0.033, respectively).

Conclusions: Higher admission glycaemia in patients treated with pPCI for STEMI predicts failed myocardial tissue reperfusion and 180-day mortality, independently of prior or acute diabetic status.

Abstract

Background and aim: Admission hyperglycaemia worsens reperfusion in ST-segment elevation myocardial infarction (STEMI). ST-segment elevation resolution parallels myocardial tissue reperfusion and predicts the outcome of primary percutaneous coronary intervention (pPCI).

Methods: We investigated whether higher glycaemia on admission impairs tissue-level reperfusion after pPCI for STEMI, as­sessed with the single-lead Schröder method of ST-segment resolution analysis (maxSTE).

Results: Among 323 patients (60.4 ± 11.5 years, 27.8% female), 13.4% of nondiabetic subjects and 58.2% of those with known diabetic history (17%) were admitted with glycaemia > 11.1 mmol/L. Failed tissue reperfusion, recognised if high-risk maxSTE criteria were fulfilled, was present among 25% of patients. The overall 180-day mortality rate was 6.8% (n = 22). Admission glycaemia ≥ 8.75 mmol/L appeared as the single risk factor for failed tissue reperfusion (ROC area = 0.638, standard error = 0.038, p < 0.001). Even after adjustment for diabetes history, patients with admission glycaemia ≥ 8.75 mmol/L (44.5%) had 2.36-fold higher risk (95% confidence interval [CI] 1.25–4.46, p = 0.008) of failed tissue reperfusion. After exclusion of patients with known diabetes and those with acute blood glucose level > 11.1 mmol/L (28%), admission glycaemia remained an independent predictor of failed tissue reperfusion (odds ratio [OR] 1.32, 95% CI 1.03–1.69, p = 0.028). Admission glycae­mia and failed tissue reperfusion (high- vs. low-risk maxSTE category) were the independent predictors of 180-day mortality (OR 1.18, 95% CI 1.05–1.32, p = 0.004 and OR 3.84, 95% CI 1.12–13.21, p = 0.033, respectively).

Conclusions: Higher admission glycaemia in patients treated with pPCI for STEMI predicts failed myocardial tissue reperfusion and 180-day mortality, independently of prior or acute diabetic status.

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Keywords

admission hyperglycaemia, resolution of ST-segment elevation, myocardial reperfusion, primary angioplasty

About this article
Title

Higher admission glycaemia independently of diagnosed or unrecognised diabetes mellitus is a risk factor for failed myocardial tissue reperfusion and higher mortality after primary angioplasty

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 3 (2018)

Pages

594-601

Early publication date

2017-12-15

Page views

357

Article views/downloads

282

DOI

10.5603/KP.a2017.0258

Bibliographic record

Kardiol Pol 2018;76(3):594-601.

Keywords

admission hyperglycaemia
resolution of ST-segment elevation
myocardial reperfusion
primary angioplasty

Authors

Łukasz Kalińczuk
Kamil Zieliński
Jerzy Pręgowski
Jakub Przyłuski
Maciej Karcz
Paweł Bekta
Michał Ciszewski
Zofia Dzielińska
Adam Witkowski
Marcin Demkow

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