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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
- Publication Year :
- 2012
-
Abstract
- 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).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.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; P0.001). 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.In hyperglycemic patients with STEMI, optimal peri-procedural glycemic control by reducing oxidative stress and inflammation may improve the outcome after PCI.
- Subjects :
- Blood Glucose
medicine.medical_specialty
Acute ST-Elevation Myocardial Infarction
medicine.medical_treatment
Endocrinology, Diabetes and Metabolism
Clinical Biochemistry
Myocardial Infarction
Glycemic Control
Coronary Angiography
Biochemistry
Coronary Restenosis
Electrocardiography
Endocrinology
Restenosis
Coronary Restenosi
Angioplasty
Internal medicine
medicine
Stent
Humans
cardiovascular diseases
Myocardial infarction
Prospective Studies
Angioplasty, Balloon, Coronary
Glycemic
Glycated Hemoglobin
Hemoglobin A, Glycosylated
In-Stent Restenosi
biology
business.industry
Insulin
C-reactive protein
Biochemistry (medical)
Percutaneous coronary intervention
medicine.disease
Prospective Studie
Conventional PCI
Cardiology
biology.protein
Early Percutaneous Coronary Intervention
Stents
business
Human
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....051858e6d36010165f997a88918b9237