Acute hyperglycemia causes microvascular  damage, leading to poor functional recovery  and remodeling in patients with reperfused  ST-segment elevation myocardial infarction.
BACKGROUND
Although acute hyperglycemia (AHG) is associated with poor outcomes in ST-segment elevation myocardial infarction (STEMI) patients, underlying mechanisms have not been fully elucidated. We investigated the influence of AHG on myocardial microcirculation in reperfused STEMI patients.


RESULTS
Thirty-four STEMI patients were divided into 2 groups according to the presence (Group H, n 5 11) or the absence (Group L, n 5 23) of AHG. Myocardial blood flow (MBF) and myocardial flow reserve (MFR) in the infarct-related area were compared between 2 groups, using ¹³N-ammonia positron emission tomography. Wall motion abnormality scores (WMASs) and end-diastolic volume indices (EDVI) were also assessed at 1 and 6 months after the onset. Although resting MBF was similar, MFR was lower in Group H than in Group L (1.69 ± 0.37 vs 2.39 ± 0.56, P = .001). WMAS was greater in Group H than in Group L at both 1 month (7.4 ± 3.7 vs 3.7 ± 3.0, P = .011) and 6 months (7.3 ± 3.9 vs 3.1 ± 3.4, P = .015). EDVI tended to be greater in Group H than in Group L at 6 months (103.8 ± 42.9 vs 73.9 ± 16.0 mL/m2, P = .071). Multivariate analysis showed AHG to be independently associated with low MFR.


CONCLUSIONS
In STEMI patients, AHG impaired myocardial microcirculation, leading to poor functional recovery and remodeling despite successful reperfusion.
First Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Fukui, Japan.
Katsuhiko
K
Sarazawa
Akira
A
Nakano
Hiroyasu
H
Uzui
Yasuhiko
Y
Mitsuke
Tohru
T
Geshi
Hidehiko
H
Okazawa
Takanori
T
Ueda
Jong-Dae
JD
Lee
D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D017566:Microvascular Angina / Q000000981:diagnostic imaging* / Q000209:etiology*; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D055414:Myocardial Perfusion Imaging / Q000379:methods; D015425:Myocardial Reperfusion; D020127:Recovery of Function; D016896:Treatment Outcome; D020257:Ventricular Remodeling