Abstract
Although percutaneous coronary intervention (PCI) significantly improves the prognosis for myocardial infarction, the no-reflow phenomenon is still the major adverse complication of PCI leading to increased mortality, especially for the patients with ST-segment elevation myocardial infarction (STEMI) combined with diabetes. To reduce the occurrence of no-reflow, prognostic factors must be identified for no-reflow phenomenon before PCI. A total of 262 participants with acute STEMI and diabetes were recruited into our cardiovascular center and underwent primary PCI for the analyses of prognostic factors of no-reflow. The patients were divided into two groups according to thrombolysis in myocardial infarction (TIMI): the normal flow and no-reflow groups, and related factors were analyzed with different statistical methods. In the present investigation, the in-hospital peak glycemia was significantly higher in the no-reflow group than the normal flow group, while more narrowed vessels, higher level of initial TIMI flow, were observed in the patients of the no-reflow group. A multivariate logistic regression analysis further demonstrated that peak glycemia was an independent predictor for no-reflow in the diabetic patients with STEMI. Our data indicated the importance of the proper control of glucose before PCI for the diabetic patients with STEMI before PCI to reduce the occurrence of the no-reflow after operation.
Highlights
Even though the therapeutic methods for patients with acute coronary syndrome (ACS) and stable coronary artery disease (CAD) have been substantially developed, angiographic optimal percutaneous coronary intervention (PCI) is still the preferred treatment for these patients, especially for patients with ST-elevation myocardial infarction (STEMI), a common form of acute myocardial infarction (AMI) [1,2,3]
A total of 262 patients with STEMI combined with diabetes were recruited for the study, which were divided into two groups according to the thrombolysis in myocardial infarction (TIMI) flow grade after primary PCI
The no-reflow group comprised of 142 participants with flow grade 0-1, and the normal flow comprised of 120 participants with TIMI flow grade 2-3
Summary
Even though the therapeutic methods for patients with acute coronary syndrome (ACS) and stable coronary artery disease (CAD) have been substantially developed, angiographic optimal percutaneous coronary intervention (PCI) is still the preferred treatment for these patients, especially for patients with ST-elevation myocardial infarction (STEMI), a common form of acute myocardial infarction (AMI) [1,2,3]. The occurrence of no-reflow is rare among patients with PCI, the serious complication of reperfusion in patients with STEMI leads to poor prognosis and increased mortality [12,13,14]. To illustrate the prognostic factors of no-reflow phenomenon before PCI in patients with AMI is critically useful to provide guidance for surgeons and to prevent the occurrence of no-reflow. An increasing number of cardiovascular risk factors are reported as potential predictive events to reduce the incidence of NR before the procedure, including hypertension control [15, 16] and use of statins [17] before the PCI. Studies demonstrated that optimal blood sugar control before PCI could significantly reduce the increased rate of no-reflow for patients with diabetes [15, 18]. The precise management of hyperglycemia in patients with diabetes is still lacking, and the range of in-hospital peak glycemia for the prognostic role of no-reflow has not yet been defined in patients with STEMI combined with diabetes
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