PMID- 21347741 OWN - NLM STAT- MEDLINE DCOM- 20111215 LR - 20220318 IS - 1861-0692 (Electronic) IS - 1861-0684 (Linking) VI - 100 IP - 8 DP - 2011 Aug TI - Impact of hyperglycemia at admission in patients with acute ST-segment elevation myocardial infarction as assessed by contrast-enhanced MRI. PG - 649-59 LID - 10.1007/s00392-011-0290-7 [doi] AB - BACKGROUND: Blood glucose level at admission in ST-segment elevation myocardial infarction (STEMI) is a predictor of heart failure and mortality. This study was performed to investigate the impact of hyperglycemia at admission in non-diabetic patients on infarct size, microvascular obstruction, and long-term outcome using contrast-enhanced magnetic resonance imaging (CMR) in patients with acute STEMI. METHODS: One hundred and seven consecutive patients (84 males; mean age 59.4 years +/- 11.3 years) with a first acute STEMI successfully treated by primary PCI were included. Admission hyperglycemia was defined as blood glucose above 7.8 mmol/l. CMR was performed 3.6 days +/- 1.9 days after admission on a 1.5-tesla MR system. The imaging protocol included single-shot steady-state free precession (SSFP) cine sequences for assessing segmental and global left ventricular (LV) function and microvascular obstruction (MVO)/late gadolinium enhancement (LGE) imaging immediately and 10 min after the administration of 0.2 mmol gadodiamide/kg of body weight using an inversion-recovery SSFP (IR-SSFP) sequence. A receiver operating characteristics analysis was used to detect the best cut-off point of microvascular obstruction that predicted myocardial infarction and death during follow-up. RESULTS: Of 107 patients, 37 (35%) had hyperglycemia on admission. Compared to normoglycemic patients, patients with admission hyperglycemia had a lower LV ejection fraction (38.6 +/- 13.7% vs. 47.5 +/- 12.2%, p < 0.001), greater ESV (88.8 +/- 41.8 ml vs. 72.3 ml +/- 35.1 ml, p = 0.01), greater infarct size (LGE% 21.1 +/- 14.9% vs. 9.8 +/- 8.7%, p < 0.001), and greater MVO (MVO% 9.6 +/- 9.9% vs. 2.5 +/- 4.3%, p < 0.001). Admission hyperglycemia was an independent predictor of the presence and extent of microvascular obstruction. Microvascular obstruction as a percentage of left ventricular mass was the only variable independently related to clinical outcome in a Cox proportional hazard model (Wald 18.78, HR 1.155, p < 0.001). CONCLUSION: Hyperglycemia at admission in STEMI patients who are successfully treated by PCI is independently associated with the presence and extent of microvascular obstruction on contrast-enhanced CMR. Thus, microvascular obstruction as assessed by CMR may be a mechanism that relates admission hyperglycemia in acute STEMI to worse outcome. FAU - Jensen, Christoph J AU - Jensen CJ AD - Department of Cardiology and Angiology, Elisabeth Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany. c.jensen@contilia.de FAU - Eberle, Holger C AU - Eberle HC FAU - Nassenstein, Kai AU - Nassenstein K FAU - Schlosser, Thomas AU - Schlosser T FAU - Farazandeh, Mani AU - Farazandeh M FAU - Naber, Christoph K AU - Naber CK FAU - Sabin, Georg V AU - Sabin GV FAU - Bruder, Oliver AU - Bruder O LA - eng PT - Journal Article DEP - 20110224 PL - Germany TA - Clin Res Cardiol JT - Clinical research in cardiology : official journal of the German Cardiac Society JID - 101264123 RN - 0 (Contrast Media) RN - AU0V1LM3JT (Gadolinium) SB - IM MH - Aged MH - Angioplasty, Balloon, Coronary MH - Arterial Occlusive Diseases/etiology/*physiopathology MH - Contrast Media MH - Coronary Angiography MH - Electrocardiography MH - Female MH - Follow-Up Studies MH - Gadolinium MH - Humans MH - Hyperglycemia/*physiopathology MH - Magnetic Resonance Imaging/*methods MH - Male MH - Microvessels/*physiopathology MH - Middle Aged MH - Myocardial Infarction/*physiopathology/therapy MH - Prospective Studies MH - Ventricular Function, Left/physiology EDAT- 2011/02/25 06:00 MHDA- 2011/12/16 06:00 CRDT- 2011/02/25 06:00 PHST- 2010/09/06 00:00 [received] PHST- 2011/01/26 00:00 [accepted] PHST- 2011/02/25 06:00 [entrez] PHST- 2011/02/25 06:00 [pubmed] PHST- 2011/12/16 06:00 [medline] AID - 10.1007/s00392-011-0290-7 [doi] PST - ppublish SO - Clin Res Cardiol. 2011 Aug;100(8):649-59. doi: 10.1007/s00392-011-0290-7. Epub 2011 Feb 24.