ASSOCIATION OF HYPERGLYCEMIA WITH NO-REFLOW OR SLOW REFLOW IN PATIENTS WITH STEMI UNDERGOING PPCI

Abstract

Background: Primary percutaneous coronary intervention (PPCI) is associated with no-reflow and slow-reflow phenomena in patients with ST-elevation myocardial infarction (STEMI) which is associated with larger infarct size, ventricular dysfunction and mortality. Patients with hyperglycemia at admission have poor outcomes, but there are limited data in people with diabetes, particularly in the region of South Asia.

Objective: To assess the association between admission hyperglycemia and no-reflow/slow-reflow in diabetic STEMI patients undergoing primary percutaneous coronary intervention.

Methods: A prospective cohort study with consecutive sampling of 116 diabetic STEMI patients (58 hyperglycemic, 58 normoglycemic) in NICVD Karachi over a period of six months. Hyperglycemia was considered as admission glucose level ≥180 mg/dL. The coronary flow was evaluated using TIMI grading, and the adjusted relative risk for no-reflow/slow flow was estimated by Modified Poisson Regression.

Results: Hyperglycemic patients were more likely to experience no-reflow/slow-flow than were normoglycemic patients (63.8% vs 19.0%, p < 0.001). Unadjusted RR = 3.36 (95% CI: 1.92 – 5.88). With adjustment, hyperglycemia was still emerged as an independent predictor (ARR = 2.98; 95% CI: 1.68 – 5.28; p < 0.001). Time of ischemia (ARR = 1.12 per 10 min; p = 0.003) and time from door-to-balloon (ARR = 1.08 per 10 min; p = 0.028) were significantly associated. Patients with hyperglycemia experienced more arrhythmias (20.7% vs. 3.4%; p = 0.004), stent thrombosis (12.1% vs. 1.7%; p = 0.032), and death rate (20.7% vs. 1.7%; p = 0.001).

Conclusion: Admission hyperglycemia is an independent predictor of no-reflow/slow-flow in diabetic STEMI patients. The routine measurement of glucose levels at presentation will allow for early risk stratification and may lead to more intensive management to achieve better outcomes.