Comparison of myocardial reperfusion in patients with fasting blood glucoseor =100, 101 to 125, and125 mg/dl and ST-elevation myocardial infarction with percutaneous coronary intervention

Diabetes and impaired fasting glucose (FG) were associated with worse outcomes in patients with acute myocardial infarction (MI). Because the underlying mechanism is not entirely clear, 376 consecutive patients with ST-elevation MI who underwent primary percutaneous coronary intervention (PPCI) were investigated. Patients were divided into 3 groups based on FGor =100, FG of 101 to 125, and FG125 mg/dl or previously diagnosed diabetes mellitus (DM) and studied for electrocardiographic signs of myocardial reperfusion (both spontaneous and after PPCI) and clinical outcomes. Clinical reperfusion was less likely with increasing FG: FGor =100 mg/dl, 26%; FG of 101 to 125, 19%; and FG125 and/or DM, 16% (p for trend = 0.03). Accordingly, angiographic TIMI grade 3 flow on initial angiography was 22% for FGor =100 mg/dl, 13% for FG of 101 to 125, and 14% for FG125 and/or DM (p for trend = 0.05). Despite similar TIMI flow after PPCI, early ST-segment resolution (or =70%) was noted in 76%, 63%, and 60% in patients with FGor =100 mg/dl, FG of 101 to 125, and FG125 and/or DM, respectively (p for trend0.01). Peak creatine phosphokinase (CPK) increased gradually, whereas left ventricular ejection fraction decreased with increased FG. Worse outcomes were observed with increasingly higher FG for heart failure (9%, 23%, and 26%; p for trend0.01), cardiogenic shock (5%, 7%, and 13%; p for trend = 0.02), in-hospital mortality (1%, 2%, and 6%; p for trend = 0.01), and long-term mortality (2.5%, 4.5%, and 12%; p for trend0.01) for patients with FGor =100 mg/dl, FG of 101 to 125, and FG125 and/or DM, respectively. In conclusion, increased FG and previously diagnosed DM were associated with less spontaneous reperfusion and less myocardial reperfusion after PPCI, resulting in worse clinical outcomes.