Page 142 - Coronary hemodynamics in acute myocardial infarction - Matthijs Bax
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Chapter 8
Association between admission glucose and microvascular function at 1-week and 6-month follow-up
At one week follow-up, intracoronary physiology measurements in the IRA and reference vessel were repeated in 62 patients (Tab. 2). No significant association was found between admission glucose levels and CFVRIRA, bAPVIRA, as well as hAPVIRA measured at 1-week follow-up.
Univariate analysis revealed that admission glucose was significantly associated with CFVRreference (std beta=−0.284; p=0.025), BMRreference (std beta=−0.280; p=0.029), and dMRreference (std beta=−0.295; p=0.021). However, after adjustment for the identified confounders, none of these variables retained a significant association.
At 6-month follow-up, intracoronary physiology measurements in the IRA and reference vessel were repeated in 61 patients (Tab. 2). Univariate analysis revealed that admission glucose at times of the PPCI was only associated with CFVRreference measured at 6-month follow-up, although this association was eclipsed after adjusting for the identified confounders. Univariate analysis revealed no association between admission glucose levels, BAPV, hAPV and CFVR at 6-month follow-up.
Discussion
We observed that increased admission glucose levels in the acute setting of STEMI are independently associated with alterations in microvascular function, particularly during resting, autoregulated conditions. Increasing glucose levels were associated with progressive impairment of reference vessel CFVR measured directly after PPCI, which resulted from increased bAPV secondary to decreased BMR. At 1-week and 6-month follow-up, the existing associations present in the acute setting disappeared, suggesting recovery of coronary autoregulatory function at normalisation of glucose levels.
It has been reported that age, heart rate and infarct size affect myocardial blood flow by influencing myocardial microvascular function.12-15 Our results confirm this, and add that blood glucose, likely secondary to acute metabolic
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