title: Peri-procedural tight glycemic control during early percutaneous coronary intervention up-regulates endothelial progenitor cell level and differentiation during acute ST-elevation myocardial infarction: effects on myocardial salvage.
abstract: BACKGROUND
  We examined the effects of peri-procedural intensive glycemic control during early percutaneous coronary intervention (PCI) on the number and differentiation of endothelial progenitor cells (EPCs) and myocardial salvage (MS) in hyperglycemic patients with first ST-elevation myocardial infarction (STEMI).
  
  
  RESULTS
  We conducted a randomized, prospective, open label study on 194 patients with STEMI undergoing PCI: 88 normoglycemic patients (glucose < 140 mg/dl) served as the control group. Hyperglycemic patients (glucose ≥140 mg/dl) were randomized to intensive glycemic control (IGC) for almost 24 h after PCI (n = 54; 80-140 mg/dl) or conventional glycemic control (CGC, n = 52; 180-200 mg/dl). EPC number, differentiation, and SIRT1expression were assessed immediately before, 24 h, 7, 30 and 180 days after PCI. The primary end point of the study was salvage index, measured as the proportion of initial perfusion defect (acute technetium-99m sestamibi scintigraphy, performed 5 to 7 days after STEMI) and myocardium salvaged by therapy (6 months after STEMI). Hyperglycemic patients had lower EPC number and differentiation and lower SIRT1 levels than normoglycemic patients (P < 0.01). After the insulin infusion, mean plasma glucose during peri-procedural period was greater in CGC group than in IGC group (P < 0.001). The EPC number, their capability to differentiate, and SIRT1 levels were significantly higher in IGC group than in CGC, peaking after 24 h (P < 0.01). In the IGC group, the salvage index was greater than in patients treated with CGC (P < 0.001).
  
  
  CONCLUSIONS
  Optimal peri-procedural glycemic control, by increasing EPC number and their capability to differentiate, may improve the myocardial salvage.
authors.affiliation: Department of Geriatrics and Metabolic Diseases Second University of Naples, Italy. Electronic address: raffaele.marfella@unina2.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Marfella
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Rizzo
authors.forename: Mario
authors.initials: M
authors.lastname: Siniscalchi
authors.forename: Pasquale
authors.initials: P
authors.lastname: Paolisso
authors.forename: Michelangela
authors.initials: M
authors.lastname: Barbieri
authors.forename: Celestino
authors.initials: C
authors.lastname: Sardu
authors.forename: Antonella
authors.initials: A
authors.lastname: Savinelli
authors.forename: Nicola
authors.initials: N
authors.lastname: Angelico
authors.forename: Salvatore
authors.initials: S
authors.lastname: Del Gaudio
authors.forename: Nicolino
authors.initials: N
authors.lastname: Esposito
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Rambaldi
authors.forename: Nunzia
authors.initials: N
authors.lastname: D'Onofrio
authors.forename: Luigi
authors.initials: L
authors.lastname: Mansi
authors.forename: Ciro
authors.initials: C
authors.lastname: Mauro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Paolisso
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Balestrieri
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001786:Blood Glucose / Q000378:metabolism; D002454:Cell Differentiation / Q000502:physiology; D002478:Cells, Cultured; D042783:Endothelial Cells / Q000378:metabolism; D005500:Follow-Up Studies; D038321:Glycemic Index / Q000502:physiology; D009203:Myocardial Infarction / Q000097:blood / Q000601:surgery; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D016879:Salvage Therapy / Q000379:methods; D013234:Stem Cells / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose
keywords: AMI; CGC; EPCs; Endothelial progenitor cells; IGC; MS; Myocardial infarction; PBMC; PCI; SIRT1; ST-segment elevation myocardial infarction; STEMI; acute myocardial infarction; conventional glycemic control; endothelial progenitor cells; intensive glycemic control; myocardial salvage; percutaneous coronary intervention; peripheral blood mononuclear cells; silent information regulator 1