The Association of Blood Glucose Level on Admission and Pre-/Post-procedural TIMI Flow with Mortality in Patients with ST Segment Elevation Myocardial Infarction Undergoing Primary PCI
Author : A. Mahavira, S. Dharma, N. Haryono
Upload Date : 19-04-2018
Background: The association of high blood glucose level and Thrombolysis In Myocardial Infarction (TIMI) flow before/after primary angioplasty with 1-year mortality has not much been explored. Objective:This study sought to determine the association of blood glucose level (BGL) on admission and pre-/post-procedural TIMI flow with 1-year mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Methods: 856 patients with STEMI and treated with primary PCI between January 2014 and July 2016 were retrospectively analyzed. The cut-off used for a high BGL in this study was ≥169 mg/dL. Survival at 1-year was assessed by Kaplan-Meier method.
Results: Patients with BGL ≥169 mg/dL (N=307) had higher proportion of final TIMI flow 0-1 [3.3% vs. 0.5%; adjusted odds ratio (OR)= 5.58, 95% confidence interval (CI) 1.30 to 23.9; p=0.02] and higher 1-year mortality [16.3% vs. 6%; adjusted hazard ratio (HR)= 1.9, 95% CI 1.12 to 3.23, p=0.017] compared with lower BGL patients (N=549). Final TIMI flow 0-1 was an independent predictor of 1-year mortality (HR= 7.0, 95% CI 3.23 to 15.15; p<0.001). Compared with patients with lower BGL, cumulative survival at 1-year was significantly lower in patients with high BGL (log-rank test, p< 0.001).
Conclusion: Patients with acute STEMI who are presented with high blood glucose level have higher proportion of final TIMI flow 0-1 after primary PCI and are associated with lower survival at 1-year compared with patients with lower BGL. Final TIMI flow 0-1 was found to be an independent predictor of 1-year mortality. Further studies are warranted to evaluate the direct mechanism between high blood glucose and final TIMI flow.
KEYWORDS : STEMI, blood glucose, TIMI flow, 1-year mortality
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