IMPACT OF DIABETES MELLITUS ON MICROVASCULAR MYOCARDIAL PERFUSION AND LEFT VENTRICULAR REMODELING IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION TREATED WITH PRIMARY CORONARY INTERVENTION

Abstract

Background: Diabetes mellitus (DM) is associated with a greater risk of cardiovascular disease and almost one third of patients with acute myocardial infarction (AMI) may have undiagnosed DM on admission. DM is associated with abnormal endothelial function, increased inflammatory response, increased platelets and leukocytes plugging and seems to be an important factor deteriorating microvascular reperfusion in acute phase of MI. Objective: The purpose of this study was to evaluate the impact of diabetes mellitus on: (1) Myocardial microvascular reperfusion after primary PCI in patients with acute myocardial infarction utilizing two well validated measures of myocardial reperfusion, resolution of ST- segment elevation and myocardial blush grade (MBG) and (2) Left ventricular systolic function recovery and incidence of remodeling after primary PCI in patients with acute myocardial infarction. Patients and Methods: The study population consisted of 100 patients with STEMI (50 diabetic and 50 non-diabetic) conducted at coronary care unit of El-Zyton specialized hospital .All patients underwent Primary percutaneous coronary intervention (1ry PCI), ECG (pre and post PPCI) to assess ST segment resolution and Conventional 2D echocardiography to asses left ventricular ejection fraction ( LVEF) (by M-Mode and Simpson rule), end diastolic volume (EDV) and end systolic volume (ESV) and wall motion score index(WMSI) was done within 72hr of admission and after 3 months later and patients with LV remodeling, i.e. an increase >20% in LV end-diastolic volume (LVEDV), were identified. Results: No significant difference was found regarding baseline demographic, clinical and lab data except in dyslipidemic number of patients (92% in diabetic group vs. 36% in non-diabetic group. There was a statistically significant difference between both studied groups as regard ECG post PPCI finding, no significant difference between 2 groups as regard baseline ECHO (EF by M-Mode, EF by Simpsons rule, LVEDV, LVESV, E/A ratio, deceleration time (DT) and wall motion score index). As regard coronary angiography and 1ry PCI data there was a significant difference between diabetic and non-diabetic group as regard number of diseased vessel and myocardial blush grade (MBG): MBG(0) was 1 % in diabetic group and was 1% in non-diabetic group, MBG (1) was 12 % in diabetic group and was 4% in non-diabetic group ,MBG(2) was 48 % in diabetic group and was 14% in non-diabetic group and MBG(3) was 38 % in diabetic group and was 80% in non-diabetic group . Conclusion: The microvascular reperfusion in STEMI patients with diabetes was worse than STEMI patients without diabetes. The incidence of remodeling was more in STEMI patients with diabetes than STEMI patients without diabetes.