Kasem Soheir M, Saied Ghada Mohamed, Hegazy Abdel Nasser Ma, Abdelsabour Mahmoud
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt.
Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt.
Front Cardiovasc Med. 2021 May 10;8:647366. doi: 10.3389/fcvm.2021.647366. eCollection 2021.
Myocardial blush grading is considered to be a novel tool for assessment of coronary microvasculature and myocardial perfusion in patients undergoing coronary angiography and angioplasty, and its reduction identifies patients at high risk. Our study aimed to evaluate the association between acute insulin resistance and myocardial blush in non-diabetic patients with ST-segment elevation myocardial infarction (STEMI). Two hundred forty non-diabetic patients with STEMI who underwent primary percutaneous coronary intervention were consecutively recruited. The relationship of homeostasis model assessment-estimated insulin resistance (HOMA-IR) to myocardial blush and in-hospital outcome was investigated. Higher HOMA-IR tertile was observed in obese patients, with hyperinsulinemia, had Killip class >1, with higher CPK-MB level and was correlated to impaired myocardial blush after adjusting for the other confounding risk factors. It was also concluded that higher HOMA-IR was independently associated with no/minimal myocardial blush after STEMI. Moreover, it was founded to be an independent predictor of pulmonary edema and impaired left ventricular systolic function. This study revealed that acute insulin resistance was prevalent in non-diabetic patients with STEMI and was an independent predictor for post-infarction myocardial and microvascular injury and poor in-hospital outcome. The trial was registered at the registry of Clinicaltrials.gov, ClinicalTrials.gov Identifier: NCT04651842, Date of registration: 2 December 2020 Registry URL, https://clinicaltrials.gov/ct2/show/NCT04385589?cond=Dapagliflozin+in+diabetic+patients&cntry=EG&draw=2&rank=1.
心肌灌注分级被认为是评估接受冠状动脉造影和血管成形术患者冠状动脉微血管和心肌灌注的一种新工具，其降低可识别高危患者。我们的研究旨在评估非糖尿病ST段抬高型心肌梗死（STEMI）患者急性胰岛素抵抗与心肌灌注之间的关联。连续招募了240例接受直接经皮冠状动脉介入治疗的非糖尿病STEMI患者。研究了稳态模型评估估计的胰岛素抵抗（HOMA-IR）与心肌灌注及住院结局之间的关系。在肥胖患者、有高胰岛素血症、Killip分级>1、CPK-MB水平较高的患者中观察到较高的HOMA-IR三分位数，在调整其他混杂风险因素后，其与心肌灌注受损相关。还得出结论，较高的HOMA-IR与STEMI后无/最小心肌灌注独立相关。此外，它被发现是肺水肿和左心室收缩功能受损的独立预测因子。这项研究表明，急性胰岛素抵抗在非糖尿病STEMI患者中普遍存在，并且是梗死后期心肌和微血管损伤以及不良住院结局的独立预测因子。该试验已在Clinicaltrials.gov注册，ClinicalTrials.gov标识符：NCT04651842，注册日期：2020年12月2日，注册网址，https://clinicaltrials.gov/ct2/show/NCT04385589?cond=Dapagliflozin+in+diabetic+patients&cntry=EG&draw=2&rank=1 。
