Effect of stress-induced hyperglycemia on myocardial perfusion and prognosis in elderly patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Abstract

Objective To investigate the effect of stress-induced hyperglycemia (SHG) on myocardial perfusion and clinical prognosis in elderly patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). Methods 348 elderly patients with first-time occurrence of acute ST-elevation myocardial infarction (STEMI) who underwent primary PCI within 12 hours from June 2008 to June 2010 were enrolled and followed up. All patients were divided into three groups according to serum glucose (SG) on admission: normal group (SG 11.1 mmol/L, n=108). Myocardial perfusion indexes, including ST segment resolution (STR), TIMI myocardial perfusion grade (TMPG), peak value of creatine kinase CK-MB, left ventricular ejection (LVEF), and major adverse cardiac events (MACE) of patients in three groups, were measured and compared after emergency PCI. Results The blood glucose levels were increased, ST-elevation 2 h after PCI were well declined, the percentages of patients with TMPG 2-3 were decreased and peak values of CK-MB were increased in the three groups (all P<0.01). After 12 months of follow-up, Kaplan-Meier survival analysis showed that patients of three groups had significantly different cumulative non-events survival rates 〔89.3% (100/112) vs. 85.9% (110/128), 76.3% (83/108), P<0.05〕. Multivariate Cox regression analysis showed that steady high blood glucose were the independent predictor for the occurrence of MACE in patients undergoing PCI after adjusting for age and gender, and the risk of MACE was increased by 5.811 folds in SHG group as compared with normal group (P<0.01). Conclusions Stress-induced hyperglycemia in elderly patients with STEMI can decrease myocardial perfusion level after primary PCI, which will lead to high incidence of MACE. Key words: Hyperglycemia; Myocardial infarction; Angioplasty, transluminal, percutaneous coronary; Prognosis