Research Article
Andres M
Abstract
Background: The coexistence of coronary heart disease and consequently acute myocardial infarction withpersistent ST-segment elevation (STEMI) and glucose metabolism disorders is well known. Still, glucose metabolismdisorders in the STEMI population are not fully understood. We know that diabetes mellitus (DM) is a factor disablingthe function of microcirculation, which in turn may affect the outcome of a coronary intervention.Aim: To evaluate the dynamics of ST-segment changes in ECG (electrocardiogram) in STEMI (ST-segmentelevation myocardial infarction) patients with co-existing hyperglycaemia compared to those with normoglycaemiatreated with percutaneous coronary intervention (PCI), as well as to determine this parameter in the assessment ofreperfusion effectiveness.Method: The study included 92 patients with the diagnosis of STEMI enrolled in the PCI treatment and wasdivided into groups based on the glucose levels on admission (reactive hyperglycaemia): a group with higherglucose levels on admission (Glc ≥ 7.8 mmol/L, n=46), a group with lower glucose levels on admission (Glc <7.8mmol/L, n=46) and into groups based on the concentration of HbA1c : a group with a lower HbA1c level (<6.5% (48mmol/mol), n=71) and a group with a higher level (≥ 6.5%, n=21).Results: On admission there were no significant differences in terms of clinical characteristics between thegroups of patients with normoglycemia and reactive hyperglycaemia. After PCI the patients with normoglycemia hadsignificantly higher (p=0.021) dynamics of changes in the resolution of ST-segment elevation in ECG expressed inan indicator of sum STR (resolution of ST elevation). A degree of resolution of ST elevation in ECG was significantly(p=0.021) dependent on the level of blood glucose - the higher the blood glucose level, the weaker resolution. Thepatients with the glucose levels ≥ 7.8 mmol/L had significantly higher levels of CK and CK-MB during the first 48hours of hospitalization. There was a statistically significant difference in the mean length of hospitalization betweenindividuals from the group with lower and higher blood glucose levels on admission (p=0.028). A 4-month follow-uprevealed no significant difference in the incidence of MACE in the study groups (p=0.063). A 4-year follow-up ofpatients with higher levels of blood glucose on admission showed a higher incidence of MACE (p=0.01). Thepatients with HbA1c ≥ 6.5% were older (p=0.004), had a greater BMI >30 kg/m2 (p=0.019) and the lower ejectionfraction of the left ventricle (p=0.003) compared to those with the HbA1c levels <6.5%. The incidence of MACE in 4-month and 4-year follow-up was comparable in the study population.Conclusion: Myocardial reperfusion after primary angioplasty in acute myocardial infarction, which is determinedby the degree of resolution of ST elevation in ECG, depends on the state of the glucose metabolism. The dynamicsof changes in the ST-segment in ECG, taken immediately after PCI, is lower in patients with reactivehyperglycaemia.