Peri-procedural tight glycemic control during early percutaneous coronary intervention is associated with a lower rate of in-stent restenosis in patients with acute ST-elevation myocardial infarction.
OBJECTIVE
We examined the effects of peri-procedural intensive glycemic control (IGC) during early percutaneous coronary intervention (PCI) on restenosis rate in hyperglycemic patients with ST-segment elevation myocardial infarction (STEMI).


METHODS
A total of 165 hyperglycemic patients (glucose ≥ 140 mg/dl) with first STEMI undergoing PCI were studied. Patients were randomized to IGC for almost 24 h after PCI (n = 82; glucose, 80-140 mg/dl) followed by multidose sc insulin during the hospital stay or conventional glycemic control (CGC; n = 83; glucose, 180-200 mg/dl) followed by conventional therapy. Coronary angiography was performed at study entry and at 6-month follow-up. Blood samples for glycemia, hemoglobin A1c, inflammatory markers (C-reactive protein and TNF-α), monocyte chemoattractant-protein-1, and oxidative stress (nitrotyrosine) were collected immediately before and 24 h, 30 and 180 d after PCI.


RESULTS
After insulin infusion, mean plasma glucose during the peri-procedural period was greater in the CGC group than in the IGC group (CGC, 191 ± 15 mg/dl; IGC, 145 ± 35 mg/dl; P < 0.001). After the insulin infusion period, the levels of markers of oxidative stress (nitrotyrosine), inflammation (C-reactive protein, TNF-α), and monocyte chemoattractant-protein-1 were significantly higher in CGC patients compared with IGC patients. Moreover, ICG during PCI reduces restenosis by half (48 and 24%) at 6 months. During follow-up, there was no difference in mortality rates, glucose, inflammatory and oxidative stress markers among the groups. In-stent restenosis was positively associated with mean plasma glucose levels as well as oxidative stress and inflammatory markers during the insulin infusion period.


CONCLUSIONS
In hyperglycemic patients with STEMI, optimal peri-procedural glycemic control by reducing oxidative stress and inflammation may improve the outcome after PCI.
Department of Geriatrics and Metabolic Diseases, Second University of Naples, 80138 Naples, Italy. raffaele.marfella@unina2.it
Raffaele
R
Marfella
Ferdinando Carlo
FC
Sasso
Mario
M
Siniscalchi
Pasquale
P
Paolisso
Maria Rosaria
MR
Rizzo
Fausto
F
Ferraro
Eugenio
E
Stabile
Giovanni
G
Sorropago
Paolo
P
Calabrò
Ornella
O
Carbonara
Giorgio
G
Cinquegrana
Federico
F
Piscione
Antonio
A
Ruocco
Davide
D
D'Andrea
Antonio
A
Rapacciuolo
Pasquale
P
Petronella
Alessandro
A
Bresciani
Paolo
P
Rubino
Ciro
C
Mauro
Giuseppe
G
Paolisso
D015906:Angioplasty, Balloon, Coronary; D001786:Blood Glucose / Q000032:analysis*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control*; D004562:Electrocardiography; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000503:physiopathology*; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human