Diabetes mellitus is associated with insufficient microvascular reperfusion following revascularization for anterior acute myocardial infarction.
OBJECTIVE
The purpose of this study was to test the hypothesis that lack of microvascular reperfusion following revascularization might be associated with a poor clinical outcome in diabetic patients with acute myocardial infarction (AMI).


METHODS
We studied 134 patients with a first anterior AMI who underwent successful revascularization within 6 hours. We assessed microvascular reperfusion by using electrocardiogram recordings just before revascularization and on return to the coronary care unit. Lack of microvascular reperfusion was defined as the absence of decrease of > or = 20% in the sum of ST segment elevation (sigmaST).


RESULTS
Twenty-four patients had diabetes and 110 patients did not. SigmaST before revascularization was similar between diabetic and nondiabetic patients. After revascularization, reduction of sigmaST was significantly smaller (1.3 +/- 8.4 mm vs 6.5 +/- 10.8 mm, p = 0.03), and lack of microvascular reperfusion was significantly more frequent (62.5% vs 33.6%, p = 0.01) in diabetic patients. A multivariate analysis showed that diabetes was associated with insufficient microvascular reperfusion (odds ratio 3.18, p = 0.03). Major adverse cardiac events occurred more frequently in patients with a lack of microvascular reperfusion (30.8% vs 15.9%, p = 0.04).


CONCLUSIONS
These findings suggest that lack of microvascular reperfusion following revascularization may be one of the mechanisms of a poor clinical outcome in diabetic patients with AMI.
Kurisu
Satoshi
S
Division of Cardiology, Hiroshima City Hospital, Hiroshima.
Inoue
Ichiro
I
Kawagoe
Takuji
T
Ishihara
Masaharu
M
Shimatani
Yuji
Y
Nishioka
Kenji
K
Umemura
Takashi
T
Nakamura
Suji
S
Yoshida
Masashi
M
D003326:Coronary Circulation; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D009204:Myocardial Revascularization; D011379:Prognosis; D016896:Treatment Outcome