Al-Ali Saja A, Alidrisi Haider A, Hameed Abdulameer
Internal Medicine, Basrah Health Directorate, Basra, IRQ.
Diabetes and Endocrinology, University of Basrah, College of Medicine, Basra, IRQ.
Cureus. 2022 Dec 29;14(12):e33093. doi: 10.7759/cureus.33093. eCollection 2022 Dec.
Obviously, hyperglycemia and insulin resistance (IR) are common in patients with acute ST-segment elevation myocardial infarction (STEMI). Additionally, IR is a substantial risk factor for cardiovascular diseases. The study aims to evaluate the association between IR and short-term outcomes of acute STEMI patients without diabetes mellitus in the form of reperfusion success, the occurrence of heart failure, the development of arrhythmias, and mortality.
A cross-sectional study was done from August 2021 to December 2021 in two cardiology centers in Al-Sadr Teaching hospital and Basrah Oil hospital in Basrah, Southern Iraq. Sixty-one nondiabetic hospitalized patients with acute STEMI were included in the study. Twenty-five (41%) of them received thrombolytics and 36 (59%) were managed with percutaneous transluminal coronary angioplasty. From each patient, a fasting blood sample was taken for calculation of the Homeostasis Model Assessment for IR (HOMA-IR) and triglyceride glucose index (TyG) index. The patients were evaluated within 1-week for (reperfusion success, echocardiography for calculation of the ejection fraction (EF), arrhythmias, and mortality), and within 4-weeks for mortality.
Within the tertile 3 of the HOMA-IR and TyG index, significant higher 4-week mortality (35% and 30%, respectively). Pearson correlation also showed significant and negative correlations between both HOMA-IR and TyG index values and EF. While reperfusion success, arrhythmias, and 1-week mortality did not correlate significantly with both HOMA-IR and TyG index.
IR as defined by HOMA-IR and TyG index was significantly associated with poor outcomes in patients with acute STEMI in the form of EF<55 and 4-week mortality.
显然，高血糖和胰岛素抵抗（IR）在急性ST段抬高型心肌梗死（STEMI）患者中很常见。此外，IR是心血管疾病的一个重要危险因素。本研究旨在评估IR与无糖尿病的急性STEMI患者短期预后之间的关联，包括再灌注成功率、心力衰竭的发生、心律失常的发展和死亡率。
2021年8月至2021年12月在伊拉克南部巴士拉的萨德尔教学医院和巴士拉石油医院的两个心脏病中心进行了一项横断面研究。61例非糖尿病住院急性STEMI患者纳入研究。其中25例（41%）接受了溶栓治疗，36例（59%）接受了经皮冠状动脉腔内血管成形术治疗。从每位患者采集空腹血样，用于计算胰岛素抵抗的稳态模型评估（HOMA-IR）和甘油三酯葡萄糖指数（TyG）指数。在1周内对患者进行评估（再灌注成功率、计算射血分数（EF）的超声心动图、心律失常和死亡率），并在4周内评估死亡率。
在HOMA-IR和TyG指数的第三三分位数内，4周死亡率显著更高（分别为35%和30%）。Pearson相关性分析还显示，HOMA-IR和TyG指数值与EF之间存在显著负相关。而再灌注成功率、心律失常和1周死亡率与HOMA-IR和TyG指数均无显著相关性。
以HOMA-IR和TyG指数定义的IR与急性STEMI患者的不良预后显著相关，表现为EF<55和4周死亡率。
