Improvement of postprandial hyperglycemia has a positive impact on epicardial flow of entire coronary tree in acute coronary syndromes patients.
BACKGROUND
Recent studies have shown that a global flow abnormality affects the entire coronary tree in patients with acute coronary syndrome (ACS), and that it is associated with adverse outcomes. Postprandial hyperglycemia is also thought to promote coronary endothelial dysfunction, as well as the release of inflammatory and vasoconstrictive factors. This study used the corrected Thrombolysis In Myocardial Infarction frame count (CTFC) to investigate whether optimal control of postprandial hyperglycemia improves pan-coronary flow.


RESULTS
Eighty ACS patients with postprandial hyperglycemia who had successful coronary intervention and who had undergone a 75-g oral glucose tolerance test (OGTT) were included. A second OGTT and angiogram were performed 8 months after procedures. The patients were divided according to postprandial glycemia after the second 75-g OGTT; optimal postprandial hyperglycemia was defined as a 2-h blood glucose concentration <7.8 mmol/L. Changes in the CTFC of culprit/non-culprit arteries, glucose response, and other clinical variables were compared. Forty patients improved to an optimal control at 8 months. In the culprit artery, the 8-month angiogram revealed a significantly improved CTFC among those with optimal control compared with the initial angiogram (30+/-9 vs 24+/-12, p<0.05). In contrast, the CTFC was not evidently improved among patients with suboptimal control. The CTFC at 8 months had thus obviously improved more in patients with optimal, than with suboptimal control (24+/-12 vs 30+/-11, p<0.05).


CONCLUSIONS
Optimal control of postprandial hyperglycemia improves epicardial blood flow in both arteries and this beneficial effect might be from improved coronary endothelial function.
Iijima
Raisuke
R
Division of Cardiovascular Medicine, Ohashi Hospital, Toho University School of Medicine, Tokyo, Japan. Raisuke329@aol.com
Nakajima
Rintaro
R
Sugi
Kaoru
K
Nakamura
Masato
M
D000368:Aged; D000789:Angina, Unstable / Q000503:physiopathology*; D001775:Blood Circulation / Q000502:physiology*; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D003331:Coronary Vessels / Q000503:physiopathology; D004035:Diet Therapy; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology* / Q000628:therapy*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D019518:Postprandial Period; D012039:Regional Blood Flow / Q000502:physiology; D015431:Weight Loss / Q000502:physiology
D001786:Blood Glucose