Abstract
It is now well accepted that an elevated blood glucose level is associated with increased mortality in patients presenting with acute myocardial infarction (AMI). However, the underlying mechanisms of these deleterious effects of hyperglycemia are not well understood. Impaired microvascular function, or the no-reflow phenomenon may be one of these factors. We investigated the association between hyperglycemia and the no-reflow phenomenon in patients with AMI. A total of 250 patients presenting with AMI were evaluated. The no-reflow phenomenon was found in 29 (11.6%) patients, their glucose level on hospital admission was significantly higher than patients who did not exhibit this phenomenon (16.5 ± 9.3 vs. 12. 2 ± 7.1 mmol/l; p = 0.008). There was no difference in patients characteristics except for diabetes (51.7% vs. 29.7% ;p=0.017). Maximum level of creatine kinase (CK) were significantly higher in patients with no-reflow (4320 ± 1981 vs. 2980.3 ±1955 IU, p= 0.01). Patients with no-reflow presented more frequently with heart failure (44.8% vs. 14.1%;p<0.01). In multivariate analysis the blood glucose level was an independent prognostic factor for no-reflow (OR: 1.8; 95% CI: 1.2-4, p <0.01). Hyperglycemia might be associated with impaired microvascular function after AMI, resulting in a larger infarct size and worse functional recovery.
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