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Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

BACKGROUND: Insulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic p...

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Autores principales: Trifunovic, Danijela, Stankovic, Sanja, Sobic-Saranovic, Dragana, Marinkovic, Jelena, Petrovic, Marija, Orlic, Dejan, Beleslin, Branko, Banovic, Marko, Vujisic-Tesic, Bosiljka, Petrovic, Milan, Nedeljkovic, Ivana, Stepanovic, Jelena, Djordjevic-Dikic, Ana, Tesic, Milorad, Djukanovic, Nina, Petrovic, Olga, Vasovic, Olga, Nestorovic, Emilija, Kostic, Jelena, Ristic, Arsen, Ostojic, Miodrag
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234386/
https://www.ncbi.nlm.nih.gov/pubmed/24708817
http://dx.doi.org/10.1186/1475-2840-13-73
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author Trifunovic, Danijela
Stankovic, Sanja
Sobic-Saranovic, Dragana
Marinkovic, Jelena
Petrovic, Marija
Orlic, Dejan
Beleslin, Branko
Banovic, Marko
Vujisic-Tesic, Bosiljka
Petrovic, Milan
Nedeljkovic, Ivana
Stepanovic, Jelena
Djordjevic-Dikic, Ana
Tesic, Milorad
Djukanovic, Nina
Petrovic, Olga
Vasovic, Olga
Nestorovic, Emilija
Kostic, Jelena
Ristic, Arsen
Ostojic, Miodrag
author_facet Trifunovic, Danijela
Stankovic, Sanja
Sobic-Saranovic, Dragana
Marinkovic, Jelena
Petrovic, Marija
Orlic, Dejan
Beleslin, Branko
Banovic, Marko
Vujisic-Tesic, Bosiljka
Petrovic, Milan
Nedeljkovic, Ivana
Stepanovic, Jelena
Djordjevic-Dikic, Ana
Tesic, Milorad
Djukanovic, Nina
Petrovic, Olga
Vasovic, Olga
Nestorovic, Emilija
Kostic, Jelena
Ristic, Arsen
Ostojic, Miodrag
author_sort Trifunovic, Danijela
collection PubMed
description BACKGROUND: Insulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). METHODS: In 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2(nd) and 7(th) day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2(nd) day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices. RESULTS: IR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (p = 0.001) and day 7 (p < 0.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (r = 0.331), whereas both HOMA indices correlated well with CFR (r = -0.331 to -0.386) (p < 0.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2 mm (OR 11.70, 95% CI 2.46-55.51, p = 0.002) and CFR < 2 (OR = 5.98, 95% CI 1.88-19.03, p = 0.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, p = 0.026). CONCLUSION: IR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size.
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spelling pubmed-42343862014-11-18 Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function Trifunovic, Danijela Stankovic, Sanja Sobic-Saranovic, Dragana Marinkovic, Jelena Petrovic, Marija Orlic, Dejan Beleslin, Branko Banovic, Marko Vujisic-Tesic, Bosiljka Petrovic, Milan Nedeljkovic, Ivana Stepanovic, Jelena Djordjevic-Dikic, Ana Tesic, Milorad Djukanovic, Nina Petrovic, Olga Vasovic, Olga Nestorovic, Emilija Kostic, Jelena Ristic, Arsen Ostojic, Miodrag Cardiovasc Diabetol Original Investigation BACKGROUND: Insulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). METHODS: In 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2(nd) and 7(th) day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2(nd) day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices. RESULTS: IR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (p = 0.001) and day 7 (p < 0.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (r = 0.331), whereas both HOMA indices correlated well with CFR (r = -0.331 to -0.386) (p < 0.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2 mm (OR 11.70, 95% CI 2.46-55.51, p = 0.002) and CFR < 2 (OR = 5.98, 95% CI 1.88-19.03, p = 0.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, p = 0.026). CONCLUSION: IR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size. BioMed Central 2014-04-05 /pmc/articles/PMC4234386/ /pubmed/24708817 http://dx.doi.org/10.1186/1475-2840-13-73 Text en Copyright © 2014 Trifunovic et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Investigation
Trifunovic, Danijela
Stankovic, Sanja
Sobic-Saranovic, Dragana
Marinkovic, Jelena
Petrovic, Marija
Orlic, Dejan
Beleslin, Branko
Banovic, Marko
Vujisic-Tesic, Bosiljka
Petrovic, Milan
Nedeljkovic, Ivana
Stepanovic, Jelena
Djordjevic-Dikic, Ana
Tesic, Milorad
Djukanovic, Nina
Petrovic, Olga
Vasovic, Olga
Nestorovic, Emilija
Kostic, Jelena
Ristic, Arsen
Ostojic, Miodrag
Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function
title Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function
title_full Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function
title_fullStr Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function
title_full_unstemmed Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function
title_short Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function
title_sort acute insulin resistance in st-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234386/
https://www.ncbi.nlm.nih.gov/pubmed/24708817
http://dx.doi.org/10.1186/1475-2840-13-73
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