Abstract 14211: Higher Active Glucagon-Like Peptide-1 Level on Admission Was Associated with Reduced Infarct Size in Patients with ST Elevation Acute Myocardial Infarction

Abstract

Background Incretins, enhancers of insulin secretion, are gut-derived peptides and the major incretin, glucagon-like peptide-1 (GLP-1), is decreased in patients with type-2 diabetes. Incretin enhancers and mimetics is clinically used to treat them and also reported to be cardioprotective and reduce infarct size after acute myocardial infarction (AMI). However, there is no information about blood levels of GLP-1 in patients with ST-elevation AMI, especially the levels on admission in spite of the potential clinical significance when considering the cardioprotective effect of incretin therapy.

Methods and Results Blood was withdrawn in the emergency department on admission of ST-elevation AMI. We measured the plasma levels of GLP-1(7-36) amide (the active form of GLP-1), plasma glucose, insulin, and hemoglobin A1c simultaneously. Forty-seven consecutive patients (87% men; 62±14 years; 30% diabetes) who were successfully reperfused within 12 hours (3.2±2.5 hours) after symptom onset were analyzed and followed about serum CK-MB levels every 3 hours after admission to assess the infarct size. Plasma active GLP-1 level was 2.7±1.8 pmol/L, which had no significant correlation with glucose (r=-0.17, p=0.26), insulin (r=-0.20, p=0.19), and hemoglobin A1c (r=0.02, p= 0.90) levels on admission. The lack of association between GLP-1, glucose, insulin, and hemoglobin A1c were equally observed among diabetic and non-diabetic patients subgroups. Most importantly, GLP-1 was inversely correlated with peak CK-MB after admission (r=-0.31, p=0.04). Compared with lower GLP-1 (above median; 2.8 pmol/L) patients, higher GLP-1 patients had similar onset-to-arrival time, presence of preinfarction angina, and collateral flow, but higher TIMI flow grade at initial coronary angiography (1.0±1.5 vs 0.3±0.5, p=0.03), which might have influence the association between GLP-1 and CK-MB levels.

Conclusions Higher active GLP-1 level on admission was associated with reduced infarct size in patients with reperfused ST-elevation AMI, indicating possible cardiopropective mechanism of endogenous GLP-1 on admission. It would provide useful information to assess blood level of GLP-1 in association with AMI as incretin therapy prevails.