Impact of hyperglycemia at admission in patients with acute ST-segment elevation myocardial infarction as assessed by contrast-enhanced MRI.

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.