Effects of hyperglycemia on coronary perfusion & left ventricular function in patients treated with primary percutaneous coronary intervention for acute ST elevation myocardial infarction
Keywords:Hyperglycemia, LV function, Primary percutaneous coronary intervention
Objective: To observe the effect of hyperglycemia on coronary perfusion and left ventricular function in patients treated with primary percutaneous coronary intervention for acute ST elevation myocardial infarction (STEMI).
Methodology: This descriptive case series study was conducted at Cardiology Department of Gulab Devi Chest Hospital, Lahore from October 2017 to November 2018. Consecutive patients presenting with acute ST elevation myocardial infarction were included in this study. After coronary angiography and revascularization, coronary perfusion was assessed using TIMI flow grade method. Glycosylated hemoglobin levels were also measured on the same day. Hyperglycemia was defined as HbA1c >7%. A comprehensive transthoracic echocardiogram was performed to assess the left ventricular ejection fraction (LVEF) 24 hours after procedure.
Results: Hyperglycemia was observed in 91 (39.2%) patients presented with acute STEMI. Patients with hyperglycemia had significantly lower LVEF than normoglycemic patients (55.00 ± 19.00 vs 45.00 ± 15.00, p-value=0.001). Multivariate analysis showed that hyperglycemia is an independent predictor of LV dysfunction, defined as LVEF ≤40% 24 hours after the procedure (OR=2.522, p-value =0.002). While no statistically significant association was observed between hyperglycemia and post PPCI impaired coronary perfusion (p=0.492).
Conclusion: The association between hyperglycemia (HbA1c >7%) upon hospital admission and left ventricular dysfunction in acute MI patients treated with PPCI is explained by lower left ventricular ejection fraction (≤ 40%) 24 hours after the procedure. But there is no statistically significant effect of hyperglycemia on post PCI coronary perfusion. Thus, we conclude that persistent hyperglycemia influences the post PPCI left ventricular functions in STEMI patients.
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