Association between hyperglycemia and the no-reflow phenomenon inpatients with acute myocardial infarction

Iwakura, Katsuomi; Ito, Hiroshi; Ikushima, Masashi; Kawano, Shigeo; Okamura, Atsushi; Asano, Katsuaki; Kimura, Tadashi; Tanaka, Koji; Masuyama, Tohru; Hori, Masatsugu; Fujii, Kenshi

doi:10.1016/s0735-1097(02)02626-8

Cited by 363 publications

(237 citation statements)

References 28 publications

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“…Norhammar and coworkers 20 also noted that elevated serum glucose levels in acute MI patients, regardless of a known history of diabetes, was a risk factor for reinfarction, congestive heart failure, and future cardiovascular events. Similar results were noted by Iwakura and colleagues, 21 who demonstrated that hyperglycemia in association with acute coronary syndromes predicted larger infarcts, decreased contractility, and less reperfusion by contrast echocardiography. Furnary and coworkers, 22 in a retrospective, nonrandomized study of diabetic patients undergoing CABG over a 14-year period, found that patients receiving a continuous insulin drip in the postoperative period had tighter control of serum glucose levels than patients managed with intermittent subcutaneous insulin injections, and, as a result, there was a significant decrease in perioperative mortality in the patients treated with a continuous insulin infusion (2.5% versus 5.3%; PϽ0.0001).…”

Section: Discussionsupporting

confidence: 88%

Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events

et al. 2004

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Background-This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium (GIK) solution in diabetic coronary artery bypass graft (CABG) patients would improve perioperative outcomes. Methods and Results-One hundred forty-one diabetic patients undergoing CABG were prospectively randomized to tight glycemic control (serum glucose, 125 to 200 mg/dL) with GIK or standard therapy (serum glucose Ͻ250 mg/dL) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery. GIK patients had lower serum glucose levels (138Ϯ4 versus 260Ϯ6 mg/dL; PϽ0.0001), a lower incidence of atrial fibrillation (16.6% versus 42%; Pϭ0.0017), and a shorter postoperative length of stay (6.5Ϯ0.1 versus 9.2Ϯ0.3 days; Pϭ0.003). GIK patients also showed a survival advantage over the initial 2 years after surgery (Pϭ0.04) and decreased episodes of recurrent ischemia (5% versus 19%; Pϭ0.01) and developed fewer recurrent wound infections (1% versus 10%, Pϭ0.03). Conclusions-Tight glycemic control with GIK in diabetic CABG patients improves perioperative outcomes, enhances survival, and decreases the incidence of ischemic events and wound complications.

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Section: Discussionsupporting

confidence: 88%

Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events

et al. 2004

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“…It also leads to increased endothelial dysfunction, hypercoagulability and impaired fibrinolysis [23,24]. ABG ≥ 8.9 mmol/L was found to be an independent prognostic factor of no-reflow phenomenon in the study by Iwakura et al [21]. A similar correlation was reported by Ishihara et al [25] for patients with ABG > 11.1 mmol/L.…”

Section: Discussionmentioning

confidence: 53%

“…Insulin resistance is also inducted by growth hormone and free fatty acids [6]. Stress hyperglycemia has been reported to promote platelet activation which is responsible for impaired microcirculation and cell damage exacerbation [21]. The phenomenon of hyperglycemia in serious, acute illnesses has been more widely studied in recent years.…”

Section: Discussionmentioning

confidence: 99%

Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock

et al. 2015

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“…Hyperglycemia has prothrombotic and proinflammatory effects and is associated with endothelial dysfunction 22, 23, 24. It was suggested that there is probably a link between hyperglycemia and the lack of efficacy of GIK infusion in patients with ACS.…”

Section: Discussionmentioning

confidence: 99%

One‐Year Outcome of Intensive Insulin Therapy Combined to Glucose‐Insulin‐Potassium in Acute Coronary Syndrome: A Randomized Controlled Study

Bouida

Beltaïef

Msolli

et al. 2017

JAHA

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BackgroundA number of factors may offset the cardioprotective effects of glucose‐insulin‐potassium (GIK) on outcome of patients with acute coronary syndrome, such as hyperglycemia induced by this cocktail infusion. We performed a study to evaluate the effect of intensive insulin therapy in association with GIK on 1‐year outcome in patients hospitalized for acute coronary syndrome.Methods and ResultsIn a randomized prospective controlled trial we included 772 patients with non–ST‐segment elevation acute coronary syndrome. Patients were randomized into 3 groups: GIKI2 group, who received GIK with intensive insulin therapy for 24 hours; GIK group, who received GIK with nonintensive insulin therapy; and control group, who received usual care. The primary outcome criteria were the rates of major cardiovascular events combining death, reinfarction, and stroke rate at 1 year. In addition, we measured platelet function assay‐100 and plasminogen activator inhibitor‐1 at admission and 24 hours later. Based on an intention‐to‐treat analysis, major cardiovascular events at 1 year was 12.8% in the GIKI2 group, 15.5% in the GIK group, and 20.5% in the placebo group; the difference was significant between the GIK2 and control groups (P=0.01). Platelet function assay‐100 at 24 hours decreased significantly from baseline in the control group but not in the GIKI2 group. Plasminogen activator inhibitor‐1 decreased significantly in the GIKI2 group but significantly increased in the control group. Minor hypoglycemic events were more frequent in the GIKI2 group compared with other groups.ConclusionsGIKI2 led to improvement of 1‐year outcome rates in patients with non–ST‐segment elevation acute coronary syndrome. This beneficial effect was associated with a decrease in platelet reactivity and an increase on fibrinolysis tests.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT00965406.

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Association between hyperglycemia and the no-reflow phenomenon inpatients with acute myocardial infarction

Abstract: Hyperglycemia might be associated with impaired microvascular function after AMI, resulting in a larger infarct size and worse functional recovery.

Cited by 363 publications

References 28 publications

Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events

Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events

Admission hyperglycemia in patients with acute coronary syndrome complicated by cardiogenic shock

One‐Year Outcome of Intensive Insulin Therapy Combined to Glucose‐Insulin‐Potassium in Acute Coronary Syndrome: A Randomized Controlled Study

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