Author + information
- Martino Pepea,b,
- Domenico Zannaa,b,
- Filippo Masia,b,
- Nicola Signorea,b,
- Alessandro Santo Bortonea,b,
- Annagrazia Cecerea,b,
- Antonio Titoa,b,
- Donato Quagliaraa,b and
- Stefano Favalea,b
Background: Hyperglycemia at hospital admission is common in patients with STEMI, even in the absence of diabetes mellitus and was found to be independently associated with short-term mortality. Corrected TIMI frame count (cTFC) is a quantitative parameter used to assess microvascular dysfunction, also in TIMI flow grade (TFG) 3 vessels. Aim of our observational study was to evaluate and quantify the impact of admission Plasma Glucose Level (PGL) on myocardial reperfusion.
Methods: We enrolled 149 consecutive STEMI patients addressed to primary PCI with a final TFG 3; exclusion criteria were cardiogenic shock, coronary ectasia, bypass graft lesions, previous MI, stenosis >50% of the non-culprit vessel. Post-procedural cTFC of both the culprit and a non-culprit coronary artery were calculated by two cardiologists in a double blinded fashion. We divided our population in two groups based on admission PGL < or > 140mg/dl and on the basis of history of diabetes.
Results: Compared to normoglycemic ones, hyperglycemic patients had a significantly higher cTFC in both the culprit (p<0.0001) and the non-culprit vessel (p:0.0002); diabetes history significantly impairs as well cTFC of both culprit (p<0.0001) and non-culprit vessel (p:0.0001). Moreover within the subpopulation of known diabetic patients hyperglycaemic ones showed significantly higher cTFC in both culprit (p<0.0013) and non-culprit vessel (p:0.0006). In the whole cohort admission PGL was significantly and positively associated with post pPCI cTFC of both culprit and non-culprit coronary artery (r: 0.09, p<0.0001).
Conclusions: Admission PGL affects coronary flow and myocardial perfusion even after successful pPCI; this relationship is evident also within the subpopulation of diabetic patients, suggesting that hyperglycemia is not linked to diabetes as a determinant of myocardial perfusion impairment. The further breaking finding is the negative effect of hyperglycemia also on the non-culprit vessel, that advocates a mechanism that goes beyond the culprit lesion and very likely affects the microvascular bed. Finally admission PGL > 140 mg/dl seems a reliable cut-off to discriminate patients at higher risk for adverse outcomes.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1204-326
- 2017 American College of Cardiology Foundation