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Observational Study
. 2021 Feb 2;20(1):33.
doi: 10.1186/s12933-021-01222-9.

Hyperglycemia, inflammatory response and infarct size in obstructive acute myocardial infarction and MINOCA

Pasquale Paolisso #  1 , Alberto Foà #  1 , Luca Bergamaschi  1 , Francesco Donati  1 , Michele Fabrizio  1 , Chiara Chiti  1 , Francesco Angeli  1 , Sebastiano Toniolo  1 , Andrea Stefanizzi  1 , Matteo Armillotta  1 , Paola Rucci  2 , Gianmarco Iannopollo  3 , Gianni Casella  3 , Cinzia Marrozzini  1 , Nazzareno Galiè  1 , Carmine Pizzi  4
Affiliations
Observational Study

Hyperglycemia, inflammatory response and infarct size in obstructive acute myocardial infarction and MINOCA

Pasquale Paolisso et al. Cardiovasc Diabetol. .

Abstract

Background: Hyperglycemia has been associated with increased inflammatory indexes and larger infarct sizes in patients with obstructive acute myocardial infarction (obs-AMI). In contrast, no studies have explored these correlations in non-obstructive acute myocardial infarction (MINOCA). We investigated the relationship between hyperglycemia, inflammation and infarct size in a cohort of AMI patients that included MINOCA.

Methods: Patients with AMI undergoing coronary angiography between 2016 and 2020 were enrolled. The following inflammatory markers were evaluated: C-reactive protein, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and neutrophil-to-platelet ratio (NPR). Myocardial infarct size was measured by peak high sensitivity troponin I (Hs-TnI) levels, left-ventricular-end-diastolic-volume (LVEDV) and left ventricular ejection fraction (LVEF).

Results: The final study population consisted of 2450 patients with obs-AMI and 239 with MINOCA. Hyperglycemia was more prevalent among obs-AMI cases. In all hyperglycemic patients-obs-AMI and MINOCA-NLR, NPR, and LPR were markedly altered. Hyperglycemic obs-AMI subjects exhibited a higher Hs-TnI (p < 0.001), a larger LVEDV (p = 0.003) and a lower LVEF (p < 0.001) compared to normoglycemic ones. Conversely, MINOCA patients showed a trivial myocardial damage, irrespective of admission glucose levels.

Conclusions: Our data confirm the association of hyperglycemic obs-AMI with elevated inflammatory markers and larger infarct sizes. MINOCA patients exhibited modest myocardial damage, regardless of admission glucose levels.

Keywords: Hyperglycemia; Infarct size; Inflammation; MINOCA; Obstructive acute myocardial infarction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart Study. CAG coronary angiography, AMI acute myocardial infarction, TpNOCA troponin-positive non-obstructive coronary arteries, Obs-AMI obstructive myocardial infarction, MINOCA myocardial infarction with non-obstructive coronary arteries, aBGL admission blood glucose level, aHGL admission high glucose level, aNGL admission normal glucose level
Fig. 2
Fig. 2
Inflammatory markers in obstructive Acute Myocardial Infarction and Non-obstructive acute myocardial infarction. The blue colour denotes normoglycemic patients; the red colour represents hyperglycemic patients. AMI acute myocardial infarction, MINOCA non-obstructive acute myocardial infarction, NLR Neutrophil-to-lymphocyte ratio, NPR Neutrophil-to-platelet ratio, PLR Platelet-to-lymphocyte ratio
See this image and copyright information in PMC

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