title: Diabetes mellitus is associated with insufficient microvascular reperfusion following revascularization for anterior acute myocardial infarction.
abstract: 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.
authors.affiliation: Division of Cardiology, Hiroshima City Hospital, Hiroshima.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kurisu
authors.forename: Ichiro
authors.initials: I
authors.lastname: Inoue
authors.forename: Takuji
authors.initials: T
authors.lastname: Kawagoe
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shimatani
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishioka
authors.forename: Takashi
authors.initials: T
authors.lastname: Umemura
authors.forename: Suji
authors.initials: S
authors.lastname: Nakamura
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoshida
mesh_terms: 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