The association between admission hyperglycaemia and the no-reflow phenomenon in STEMI patients undergoing primary percutaneous coronary intervention
Introduction
No-reflow phenomenon is not uncommon in acute myocardial infarction patients treated by primary percutaneous coronary intervention (PPCI). It is associated with poorer left ventricular systolic dysfunction and higher mortality in such patients.1 Diabetes was linked to increased incidence of no-reflow in PPCI.2 We hypothesised that acute admission hyperglycemia, rather than diabetes, is responsible for this complication.
Materials and methods
We prospectively studied 120 consecutive ST-elevation myocardial infarction (STEMI) patients presenting to two PPCI centres over a period of 6 months. We included all the patients eligible for PPCI according to the European Society of Cardiology (ESC) guidelines.3 We excluded patients with previous PCI and stent thrombosis and patients with previous coronary artery bypass grafting (CABG). The local research ethics committee has approved the study protocol and we followed the Helsinki declaration of research ethics in human beings including informed consents. The patients were divided into two groups based on the coronary flow post-PPCI (normal flow and no-reflow). No reflow is defined as the absence of coronary TIMI 3 flow post PCI without mechanical obstruction.1 A professional statistician did the analysis using IBM SPSS 21.0 software.
Results and discussion
The incidence of no-reflow was 17.5% (n=21). There was no significant difference between the two groups regarding the clinical characteristics and the different cardiovascular risk factors including diabetes (Table 1). The median of admission random plasma glucose (RPG) level was significantly higher in the no-reflow group (15.5 vs 8.3 mmol/L; p=0.001; Fig 1). A possible explanation is that hyperglycemia increases leucocytes’ adhesion molecules, causing microvascular obstruction and Elastase-induced endothelial damage.4 This augments thrombus formation and impairs ischaemic preconditioning.5 The study was limited by the small study population size and the narrow geographical area of recruitment.
Conclusion
Admission hyperglycemia, rather than diabetes, is associated with a higher incidence of no-reflow post-PPCI. The control of admission hyperglycaemia can help to reduce the peri-procedural complications of PPCI.
- © Royal College of Physicians 2022. All rights reserved.
References
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- Niccoli G
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- Pantea-Roșan LR
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- Ibanez B
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- Ito H
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