Effect of primary percutaneous coronary intervention on stress hyperglycaemia in myocardial infarction.

  • McGregor A
  • Leech N
  • Purcell I
 et al. 
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Abstract

Diabet. Med. 29, 1317-1320 (2012) ABSTRACT: Aim To measure the effect of primary percutaneous coronary intervention on stress hyperglycaemia induced by ST segment elevation myocardial infarction. Methods We measured blood glucose before primary percutaneous coronary intervention and 1 h after intervention in all patients presenting with ST segment elevation myocardial infarction for 2 months in our unit. A paired t-test was used for a statistical analysis. Results From 157 patients accepted for primary percutaneous coronary intervention, 90 patients were included in the analysis. Blood glucose before intervention was 8.4 ± 2.46 mmol/l (mean ± SD) and after intervention was 7.9 ± 2.0 mmol/l (mean ± sd) (P = 0.003). In the subset of 15 patients with hyperglycaemia (glucose greater than 10 mmol/l), glucose before intervention was 12.7 ± 2.62 mmol/l (mean ± SD) and after intervention was 9.8 ± 3.42 mmol/l (mean ± sd) (P = 0.0002). Conclusions Blood glucose in patients with ST segment elevation myocardial infarction is significantly lower after primary percutaneous coronary intervention and this reduction is most marked in patients with hyperglycaemia. Waiting for the stress response to diminish means that 11.1% of patients' glucose levels fell below the treatment threshold of 10 mmol/l. Using the post-intervention blood glucose level avoids the need for treatment with insulin in this population. Further randomized studies are warranted to investigate the impact on mortality and morbidity of administering insulin triggered by pre-invention blood glucose vs. post-intervention blood glucose.

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Authors

  • a K McGregor

  • N Leech

  • I F Purcell

  • R Edwards

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