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- September 9, 2010 |
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"Increased Risk of Coronary Events in Dysglycemic Patients: Mechanisms, and Reasons for Poor Outcomes"Dr. Richard W. Nesto (biography)
English - 2005-04-16 - 32 minutes
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Summary :
In recent years the early in-hospital mortality of diabetic patients after MI has been substantially reduced due to improvements in the medical management of these patients within the first 24 hours (1), however diabetes and hyperglycaemia itself still confer an increased risk of long-term mortality after MI which can be explained by a higher risk of congestive heart failure (2).
The admission blood glucose level has been found to be a risk indicator of death after MI in patients with and without diabetes (2,3). In diabetic individuals, increased platelet aggregability and adhesiveness is one factor that may contribute to poor outcomes (4). In the setting of AMI, hyperglycaemia itself has different effects. For example, hyperglycaemia has been found to predict impaired coronary flow before reperfusion therapy (5), to cause no-reflow (i.e., poor microvascular flow) (6), and to be associated with inflammatory markers and cardiac injury (7).
Increased free fatty acid availability and oxidation in the ischaemic myocardium can worsen outcomes (8), hence an interest in the use of metabolic modulators that enhance glucose oxidation and delivery to the myocytes. Dr. Nesto discusses glucose-insulin-potassium (GIK) infusion therapy for AMI, interpreting the results from the recent CREATE-ECLA trial, and concludes the presentation with remaining questions concerning the need for and manner of treating hyperglycaemia in AMI.
Copyright © 2005 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Studies relating admission blood glucose levels to in-hospital and long-term mortality after MI in diabetic and non-diabetic patients
- Mechanisms whereby hyperglycaemia in AMI leads to poor outcomes
- The role of metabolic modulators in AMI: GIK infusion therapy
- Remaining questions
Bibliographic references :
1. Oliver Schnell, MD, Oliver Schäfer, Sonja Kleybrink, Wittich Doering, MD, Eberhard Standl, MD and Wolfgang Otter, MDIntensification of Therapeutic Approaches Reduces Mortality in Diabetic Patients With Acute Myocardial Infarction: The Munich registryDiabetes Care 27:455-460, 2004.
2. Ischa Stranders, MD; Michaela Diamant, MD, PhD; Rogier E. van Gelder, MD; Hugo J. Spruijt, MSEE; Jos W. R. Twisk, PhD; Robert J. Heine, MD, PhD, FRCP; Frans C. Visser, MD, PhD. Admission Blood Glucose Level as Risk Indicator of Death After Myocardial Infarction in Patients With and Without Diabetes Mellitus Arch Intern Med. 2004;164:982-988.
3. Nazneem N. Wahab MD, Elizabeth A. Cowden MD, Neil J. Pearce MD, Martin J. Gardner MD, Heather Merry MSc, Jafna L. Cox MD and ICONS Investigators. Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? JACC.20 November 2002, Volume 40, Issue 10 Pages 1748-1754.
4. John A. Colwell, MD, PHD and Richard W. Nesto, MD.The Platelet in Diabetes: Focus on prevention of ischemic eventskjhkhkhDiabetes Care 26:2181-2188, 2003.
5. Jorik R. Timmer, Jan Paul Ottervanger, Menko-Jan de Boer, Jan-Henk E. Dambrink, Jan C.A. Hoorntje, A.T. Marcel Gosselink, Harry Suryapranata, Felix Zijlstra, Arnoud W.J. van't HofHyperglycemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarctionJACC.5 April 2005, Volume 45, Issue 7 Pages 999-1002.
6. Katsuomi Iwakura MD, Hiroshi Ito MD, FACC, Masashi Ikushima MD, Shigeo Kawano MD, Atsushi Okamura MD, Katsuaki Asano MD, Tadashi Kuroda MD, Koji Tanaka MD, Tohru Masuyama MD, Masatsugu Hori MD and Kenshi Fujii MDAssociation between hyperglycemia and the no-reflow phenomenon inpatients with acute myocardial infarctionJACC.1 January 2003, Volume 41, Issue 1 Pages 1-7.
7. Raffaele Marfella, MD, PHD, Mario Siniscalchi, MD, PHD, Katherine Esposito, MD, Ausilia Sellitto, MD, Umberto de Fanis, MD, Ciro Romano, MD, PHD, Michele Portoghese, MD, Silvio Siciliano, MD, Francesco Nappo, MD, PHD, Ferdinando Carlo Sasso, MD, PHD, Nicola Mininni, MD, Federico Cacciapuoti, MD, Giacomo Lucivero, MD, PHD, Riccardo Giunta, MD, Mario Verza, MD and Dario Giugliano, MD, PHDEffects of Stress Hyperglycemia on Acute Myocardial Infarction: Role of inflammatory immune process in functional cardiac outcome Diabetes Care 26:3129-3135, 2003.
8. Oliver MF, Opie LH. Effects of glucose and fatty acids on myocardial ischaemia and arrhythmiasLancet. 1994 Jan 15;343(8890):155-8.
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