Tsuchida Keiichi, Nakamura Norihito, Soda Satoshi, Sakai Ryohei, Nishida Kota, Hiroki Jiro, Kashiwa Asami, Fujihara Yuki, Kimura Shinpei, Hosaka Yukio, Takahashi Kazuyoshi, Oda Hirotaka
Department of Cardiology, Niigata City General Hospital.
Department of Endocrinology and Metabolism, Niigata City General Hospital.
Int Heart J. 2017 May 31;58(3):328-334. doi: 10.1536/ihj.16-250. Epub 2017 May 8.
This study was conducted to assess whether any relationships exist between glucose fluctuations and electrocardiographic surrogate markers of reperfusion injury in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).We prospectively studied 63 consecutive patients with STEMI undergoing primary PCI. Patients had either diabetes (n = 30), impaired glucose tolerance (n = 26), impaired fasting glucose (n = 1), or normal glucose tolerance (n = 6). STsegment resolution (STR, %) was measured using electrocardiograms recorded 60 minutes after PCI. STR was categorized as ≥ 30% and < 30%. Glucose fluctuations were assessed by the following parameters obtained from a continuous glucose monitoring system: mean amplitude of glucose excursion (MAGE, mg/dL); and area under curve with reference to mean blood glucose (AUC, mg/ dL/day).Both MAGE and AUC were significantly higher in STR < 30%. In univariate analysis, MAGE ≥ 70 mg/dL (OR = 17.0; 95%CI, 1.93-150.12; P < 0.01), AUC ≥ 20 mg/dL/day (OR = 10.9; 95%CI, 1.92-61.77; P < 0.01), and reperfusion arrhythmias (OR = 7.6; 95%CI, 1.32-44.29; P < 0.05) were significantly associated with suboptimal STR. Multiple logistic regression analysis showed only MAGE ≥ 70 mg/dL was predictive of suboptimal STR (OR = 22.5; 95%CI, 2.43-208.66, P < 0.01).Parameters of glucose fluctuations correlated with electrocardiographic surrogate markers of impaired myocardial salvage in STEMI after reperfusion therapy. Our results suggest that glucose fluctuations may represent a potential therapeutic target to reduce myocardial reperfusion injury in STEMI.
本研究旨在评估接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者的血糖波动与再灌注损伤的心电图替代标志物之间是否存在任何关联。我们前瞻性地研究了63例连续接受直接PCI的STEMI患者。患者分为糖尿病组（n = 30）、糖耐量受损组（n = 26）、空腹血糖受损组（n = 1）或糖耐量正常组（n = 6）。使用PCI术后60分钟记录的心电图测量ST段回落（STR，%）。STR分为≥30%和<30%。通过连续血糖监测系统获得的以下参数评估血糖波动：血糖波动幅度平均值（MAGE，mg/dL）；以及相对于平均血糖的曲线下面积（AUC，mg/dL/天）。STR<30%时，MAGE和AUC均显著更高。单因素分析中，MAGE≥70 mg/dL（OR = 17.0；95%CI，1.93 - 150.12；P < 0.01）、AUC≥20 mg/dL/天（OR = 10.9；95%CI，1.92 - 61.77；P < 0.01）和再灌注心律失常（OR = 7.6；95%CI，1.32 - 44.29；P < 0.05）与STR欠佳显著相关。多因素逻辑回归分析显示，只有MAGE≥70 mg/dL可预测STR欠佳（OR = 22.5；95%CI，2.43 - 208.66，P < 0.01）。再灌注治疗后，STEMI患者的血糖波动参数与心肌挽救受损的心电图替代标志物相关。我们的结果表明，血糖波动可能是减少STEMI患者心肌再灌注损伤的一个潜在治疗靶点。
