Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction

Katsuomi Iwakura, Hiroshi Ito, Masashi Ikushima, Shigeo Kawano, Atsushi Okamura, Katsuaki Asano, Tadashi Kuroda, Koji Tanaka, Tohru Masuyama, Masatsugu Hori, Kenshi Fujii

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Abstract

OBJECTIVES: We investigated the association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction (AMI). BACKGROUND: Hyperglycemia is associated with increased risks of heart failure, cardiogenic shock, and death after AMI, but its underlying mechanism remains unknown. METHODS: A total of 146 consecutive patients with a first AMI were studied by intracoronary myocardial contrast echocardiography (MCE) after successful reperfusion within 24 h after symptom onset. Two-dimensional echocardiography was recorded on day 1 and three months later to determine the change in the wall motion score (δWMS; sum of 16 segmental scores; dyskinesia = 4 to normokinesia = 0). RESULTS: The no-reflow phenomenon was found on MCE in 49 (33.6%) of 146 patients; their glucose level on hospital admission was significantly higher than that of patients who did not exhibit this phenomenon (209 ± 79 vs. 159 ± 56 mg/dl; p < 0.0001). There was no difference in glycosylated hemoglobin or in the incidence of diabetes mellitus between the two subsets. The no-reflow phenomenon was more often observed in the 75 patients with hyperglycemia (≥160 mg/dl) than in those without hyperglycemia (52.0% vs. 14.1%; p < 0.0001). Patients with hyperglycemia had a higher peak creatine kinase level (2,497 ± 1,603 vs. 1,804 ± 1,300 IU/l; p = 0.005) and a lower δWMS (3.7 ± 4.8 vs. 5.7 ± 4.3; p = 0.01) than did those without hyperglycemia. The blood glucose level was an independent prognostic factor for no reflow, along with age, gender, absence of pre-infarction angina, complete occlusion of the culprit lesion, and anterior AMI. CONCLUSIONS: Hyperglycemia might be associated with impaired microvascular function after AMI, resulting in a larger infarct size and worse functional recovery.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalJournal of the American College of Cardiology
Volume41
Issue number1
DOIs
Publication statusPublished - Jan 1 2003
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Iwakura, K., Ito, H., Ikushima, M., Kawano, S., Okamura, A., Asano, K., Kuroda, T., Tanaka, K., Masuyama, T., Hori, M., & Fujii, K. (2003). Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction. Journal of the American College of Cardiology, 41(1), 1-7. https://doi.org/10.1016/S0735-1097(02)02626-8