Abstract 12365: Relationship Between Admission Blood Glucose and Microvascular Dysfunction Assessed by Cardiovascular Magnetic Resonance After Primary Angioplasty in Patients With Acute Myocardial Infarction and No Previous Diabetes

Abstract

Background: Previous studies have reported that acute hyperglycemia at hospital admission is associated with adverse outcomes after acute ST-segment elevation myocardial infarction (STEMI) in patients without diabetes mellitus. Non-invasive assessment of microvascular obstruction (MVO) by cardiovascular magnetic resonance (CMR) provides a specific biomarker of severe microvascular dysfunction. However, the relationship between acute hyperglycemia and severe microvascular dysfunction has not been fully evaluated in STEMI patients without diabetes. The aim of this study was to determine whether acute hyperglycemia was related to the presence of severe microvascular dysfunction determined by CMR in patients with acute STEMI and no previous diabetes.

Methods: The study population consisted of 103 consecutive patients with no diagnosis of diabetes and a first STEMI successfully treated with percutaneous coronary intervention (PCI). Late gadolinium-enhanced (LGE) CMR performed within 3 days after primary PCI was used to measure MVO. Acute hyperglycemia was defined as a blood glucose level of ≥190 mg/dl at admission. We assessed the association between acute hyperglycemia and microvascular dysfunction determined by CMR.

Results: Acute hyperglycemia was found in 20 patients (19%). In patients with hyperglycemia, the total sizes of MVO area was larger (3.40±4.26 vs 1.70±2.74 % of left ventricle; p=0.029), and the peak value of CPK was higher (3205±1736 vs 2275±1847 IU/l; p=0.044). By regression analysis, the values of admission blood glucose significantly correlated with LGE and MO area (r=0.23, p=0.020, r=0.22, p=0.028, respectively). Multivariate analysis showed that acute hyperglycemia was an independent predictor of MVO (odds ratio 4.73; 95% confidence interval, 1.54-17.1, p=0.0058).

Conclusion: Hyperglycemia on admission is related to severe microvascular dysfunction after primary PCI in patients with STEMI and no previous diabetes.