title: Association between hyperglycemia at admission and microvascular obstruction in patients with ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Blood glucose level at admission in ST-segment elevation myocardial infarction (STEMI) is a predictor of heart failure and mortality. A previous study showed the association between hyperglycemia and microvascular dysfunction using myocardial contrast echocardiography. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) can demonstrate microvascular obstruction (MVO) as the area with hypointense core within LGE. This study was performed to investigate the association between hyperglycemia at admission and MVO using CMR in patients with STEMI.
  
  
  METHODS
  Ninety-three patients with first STEMI who were treated by percutaneous coronary intervention (PCI) were included. CMR was performed within 7 days after PCI. Venous blood was collected routinely immediately after admission for plasma glucose determination before intravenous injection of some medications. Samples were analyzed in the hospital's central laboratory. We performed LGE-CMR to assess the presence of MVO.
  
  
  RESULTS
  MVO was found in 34 (37%) of all 93 patients; their glucose level at admission was significantly higher than that of patients who did not exhibit MVO [204 (153-267)mg/dl vs. 157 (127-200)mg/dl, p=0.002]. There were no differences in glycosylated hemoglobin and incidence of diabetes mellitus between the two groups. A multivariable logistic regression analysis showed that glucose level at admission was an independent predictor of MVO (odds ratio, 1.014; 95% confidence interval, 1.004 to 1.023; p=0.006). The glucose level at admission 190mg/dl was the best threshold value for identifying MVO. The occurrence of MVO was significantly higher in the patients with glucose level at admission ≧190mg/dl compared with the patients with glucose level <190mg/dl [18 (53%) vs. 16 (27%), p=0.023].
  
  
  CONCLUSIONS
  Hyperglycemia at admission in STEMI patients who were treated by PCI was associated with the presence of MVO assessed by LGE-CMR.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan. Electronic address: wakayama_hirosaki@yahoo.co.jp.
authors.forename: Shingo
authors.initials: S
authors.lastname: Ota
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanimoto
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Orii
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Shiono
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shimamura
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsuo
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamano
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ino
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Imanishi
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D005682:Gadolinium; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D062645:Percutaneous Coronary Intervention
chemical_list: D001786:Blood Glucose; D005682:Gadolinium
keywords: Cardiovascular magnetic resonance imaging; Hyperglycemia at admission; Microvascular obstruction