Association of hyperglycemia with initial and post procedural TIMI flow in patients with ST elevation myocardial infarction undergoing primary angioplasty

Abstract

Hyperglycemia is a common finding during hospitalization in patients with acute coronary syndrome, and it has been reported in some studies that this phenomenon is associated with increased complications and mortality. It is possible that one of the causes of higher complications in these patients is the lack of re-perfusion during hyperglycemia and the increase of advanced glycation end products. However, due to the lack of sufficient studies in this field, in this study we discussed the relationship between hyperglycemia and TIMI flow at the time of referral and final TIMI after primary angioplasty in patients with ST-segment elevation myocardial infarction (STEMI). Methods: In this cross-sectional analytical study, patients with STEMI who underwent PPCI were included in the study. Basic demographic information, tests and ECG of patients are recorded. Also, the information obtained from the patients' echocardiography and angiography will be recorded. Patients were divided into two groups: hyperglycemic (blood glucose level on admission, greater than or equal to 198 mg/dL) and normal blood sugar (blood sugar less than 198). The attending physician evaluated the flow of TIMI according to the TIMI classification, and the initial and final TIMI were recorded for the patients in two groups. Then, all the obtained information was entered into the 20SPSS.V software and analyzed by the relevant statistical tests. Results: 263 STEMI patients were examined in this study. 60 patients (22.81%) had blood sugar more than 198 mg/dL and were classified as hyperglycemic. In most of the patients, the TIMI index in the main involved vessel was 0 (202 patients (76.81%)). Patients in two groups with and without hyperglycemia had no difference in terms of TIMI index in the main vessel involved at the time of presentation (p value = 0.517). SlowFlow was observed in 46 patients (17.49%), including 10 patients (16.67%) in the hyperglycemic group and 36 patients (17.73%) in the normal blood sugar group (p value = 0.520). The highest ST segment elevation was 3.85 (±2) mm on average. After PPCI, the ST segment remained significantly elevated in the hyperglycemic group (mean ST segment height 2.16 (±1.36) compared to 1.7 (±1.29) mm in the group without hyperglycemia, 0.004 = p value). Also, the number of patients who had a more than 50% reduction in Maximim STE 90 minutes after PPCI was significantly less in the hyperglycemic group than in the non-hyperglycemic group (56.67% compared to 72.91%, p value=0.036).