Background—The Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study addressed prognostic factors and the effects of concomitant treatment and glycometabolic control in diabetic patients with myocardial infarction (AMI). Methods and Results—Of 620 diabetic patients with AMI, 306 were randomly assigned to a ≥24-hour insulin-glucose infusion followed by multidose subcutaneous insulin. Three hundred fourteen patients were randomized as controls, receiving routine antidiabetic therapy. Thrombolysis and β-blockers were administered when possible. Univariate and multivariate statistical analyses were applied to study predictors of long-term mortality. During an average follow-up of 3.4 years (range, 1.6 to 5.6 years), 102 patients (33%) in the intensive insulin group and 138 (44%) in the control group died (P=0.011). Old age, previous heart failure, diabetes duration, admission blood glucose, and admission Hb AIc were independent predictors of mortality in the total cohort, whereas...

Glycometabolic State at Admission: Important Risk Marker of Mortality in Conventionally Treated Patients With Diabetes Mellitus and Acute Myocardial Infarction

Stress hyperglycemia is commonly observed in patients suffering from ischemic heart disease. It not only worsens cardiovascular prognosis but also attenuates the efficacies of various cardioprotective agents. This study aimed to investigate the protective effect of melatonin against myocardial ischemia-reperfusion (MI/R) injury in acute hyperglycemic state with a focus on Notch1/Hes1/Akt signaling and intracellular thioredoxin (Trx) system. Sprague-Dawley rats were subjected to MI/R surgery and high glucose (HG, 500 g/L) infusion (4 ml/kg/h) to induce temporary hyperglycemia. Rats were treated with or without melatonin (10 mg/kg/d) during the operation. Furthermore, HG (33mM) incubated H9c2 cardiomyoblasts were treated in the presence or absence of Luzindole (a competitive melatonin receptor antagonist), DAPT (a γ-Secretase inhibitor), LY294002 (a PI3-kinase/Akt inhibitor) or thioredoxin-interacting protein (Txnip) adenoviral vectors. We found that acute hyperglycemia aggravated MI/R injury by suppressing Notch1/Hes1/Akt signaling and intracellular Trx activity. Melatonin treatment effectively ameliorated MI/R injury by reducing infarct size, myocardial apoptosis and oxidative stress. Moreover, melatonin also markedly enhanced Notch1/Hes1/Akt signaling and rescued intracellular Trx system by up-regulating Notch1, N1ICD, Hes1 and p-Akt expressions, increasing Trx activity and down-regulated Txnip expression. However, these effects were blunted by Luzindole, DAPT or LY294002. Additionally, Txnip overexpression not only decreased Trx activity, but also attenuated the cytoprotective effect of melatonin. We conclude that impaired Notch1 signaling aggravates MI/R injury in acute hyperglycemic state. Melatonin rescues Trx system by reducing Txnip expression via Notch1/Hes1/Akt signaling in a membrane receptor-dependent manner. Its role as a prophylactic/therapeutic drug deserves further clinical study.

This article is protected by copyright. All rights reserved.

Melatonin rescues cardiac thioredoxin system during ischemia-reperfusion injury in acute hyperglycemic state by restoring Notch1/Hes1/Akt signaling in a membrane receptor-dependent manner.

Objetivo: La asociacion entre marcadores serologicos y fraccion de expulsion en el infarto no ha sido completamente estudiada. Nuestro objetivo es estudiar la asociacion existente entre marcadores bioquimicos y disfuncion ventricular izquierda en el infarto agudo de miocardio con elevacion del segmento ST. Metodos: Con un diseno observacional, prospectivo, incluimos a pacientes con infarto con elevacion ST en las primeras 24 h. Se analizaron al ingreso: recuento de leucocitos, glucemia, peptido natriuretico tipo B y troponina T, y creatinfosfocinasa total y fraccion MB al ingreso y en forma seriada. Estos parametros se correlacionaron con la fraccion de expulsion estimada por ecocardiograma. Resultados: Se incluyeron 108 pacientes. Mediana de fraccion de expulsion 48% (intervalo intercuartilico 41-57). En el analisis de regresion lineal simple, el peptido natriuretico tipo B (p = 0.005), el pico de creatinfosfocinasa fraccion MB (p = 0.01), el recuento leucocitario (p = 0.001) y la glucemia (p = 0.033) se asociaron inversa y significativamente con la fraccion de expulsion. No mostraron asociacion los otros parametros. En el analisis de regresion lineal multiple, solo el peptido natriuretico tipo B (p = 0.01) y el pico de creatinfosfocinasa fraccion MB (p = 0.02) presentaron correlacion significativa con la fraccion de expulsion. Ambos parametros se asociaron significativamente con una fraccion de expulsion < 50%, de manera independiente a otras variables clinicas. Conclusiones: En la etapa aguda del infarto con elevacion ST, el peptido natriuretico tipo B y la creatinfosfocinasa fraccion MB se asociaron significativamente con la disfuncion ventricular izquierda independientemente de la presencia de otros marcadores bioquimicos y variables clinicas determinantes de disfuncion ventricular

http://www.scielo.org.mx/pdf/acm/v84n4/v84n4a2.pdf

Asociación entre marcadores bioquímicos y disfunción ventricular izquierda en infarto con elevación del segmento ST

UNLABELLED The diabetic patients represent a population with a high risk of morbidity and mortality because of vascular complications. Out of them, all the patients with acute ST-elevation myocardial infarction have a more reserved prognostic than those without diabetes mellitus. Moreover, the patients with impaired glucose tolerance have a more severe evolution in case of a myocardial infarction. AIM We wondered about the progress of patients with myocardial infarction and high blood glucose levels in admittance who had not been previously diagnosed with diabetes mellitus. MATERIALS AND METHODS We took 128 patients (who did not have diabetes) with acute ST-elevation myocardial infarction and divided them into three groups, according to the blood glucose level in admittance ( 200 mg/dL); we also analyzed a group of diabetics with acute myocardial infarction who were admitted in the same period in our clinic. We made a prospective analysis over a period of 30 days. We evaluated the mortality at 30 days (as primary objective), as well as the extent of the infarction and the change of the left ventricle systolic function (secondary objectives). RESULTS Both mortality and the mass of myocardial necrosis grew relative to the blood glucose level in admittance; instead, the ejection fraction varied inversely to the initial blood glucose level. CONCLUSION The admittance blood glucose level represents a useful and available marker for the initial stratification of risks in patients with acute myocardial infarction, even in those undiagnosed with diabetes mellitus.

Mincu D

Papers

The prognostic value of blood glucose level on admission in non-diabetic patients with acute myocardial infarction.