In-hospital daily insulin dose predicts long-term adverse outcome in patients with diabetes with ST-elevation myocardial infarction treated with successful primary percutaneous angioplasty.

INTRODUCTION: Early initiation of reperfusion therapy including primary percutaneous coronary revascularization (PPCI) has been recognized as a crucial factor determining clinical outcomes in the acute phase of myocardial infarction. In unstable patients with type 2 diabetes mellitus (T2D) the clear benefit from PPCI was proven. We aim to evaluate the prognostic value of factors describing glycometabolic state on admission in patients with T2D undergoing PPCI in acute ST-elevation myocardial infarction (STEMI). MATERIAL AND METHODS: Prospective analysis of clinical and laboratory variables (mean daily short acting exogenous insulin dose (DID), admission blood glucose, glycated hemoglobin (HbA1c), microalbuminuria) was performed in 112 consecutive patients with T2D with STEMI who underwent PPCI. Women comprised 58% of the group. RESULTS: Insulin dosing was targeted to obtain a mean daily glucose level < 7.8 mmol/l. During 12-month follow-up 33 (29.5%) major adverse cardiac events (major adverse cardiac events (MACE) consisting of death, reinfarction, and repeated target vessel revascularization) were reported. Microalbuminuria was present in 68 (60.5%) patients. The mean HbA1c level was 7.9%. In the multivariate logistic regression model only DID > 44 IU remained an independent risk factor for MACE (p = 0.02, OR = 5.2). CONCLUSIONS: In patients with diabetes with STEMI treated with PPCI, simple measurement of DID during hospitalization can add valuable prognostic information about the future risk of MACE.

Effect of intracoronary injection of mononuclear bone marrow stem cells on left ventricular function in patients with acute myocardial infarction.

To investigate the effect of intracoronary injection of autologous mononuclear bone marrow stem cells (BMSCs) in patients with ST-elevation myocardial infarction (STEMI) on left ventricular (LV) systolic and diastolic function using standard echocardiography and 2-dimensional systolic strain. A total of 60 patients with first anterior wall STEMI and LV ejection fraction of <40%, treated with successful primary percutaneous coronary intervention were randomly assigned to the treatment group (BMSC group) or the control group in a 2:1 ratio. Transcatheter intracoronary injection of BMSCs into the infarct-related artery was performed 7 days after STEMI. Standard echocardiography and speckle tracking analysis was performed at baseline and 6 months after STEMI. No differences were found in the baseline echocardiographic parameters of LV systolic and diastolic dysfunction--the LV ejection fraction was 35 +/- 6% in the BMSC group, similar to that in the control group (33 +/- 7%, p = 0.42). After 6 months, the absolute change in the LV ejection fraction was significantly greater in the BMSC group than in the control group (10 +/- 9% versus 5 +/- 8%, p = 0.04). Significant improvement was seen in 2-dimensional systolic strain in all segments (12 +/- 4 vs 14 +/- 4; p = 0.0009) and in the infarcted area (5 +/- 2 vs 6 +/- 2; p = 0.0038) only in the BMSC group. Of the diastolic function parameters, we observed improvement in the early filling propagation velocity (30 +/- 8 cm/s vs 37 +/- 13 cm/s; p = 0.0008), early diastolic velocity - E' (4.5 +/- 1.5 vs 5.0 +/- 1.3, p = 0.02), and the E/E' ratio (17 +/- 7 vs 14 +/- 5; p = 0.03) in the BMSC group. In conclusion, intracoronary injection of unselected BMSCs in patients with STEMI improved both LV systolic and diastolic function at 6 months of follow-up.

Intracoronary administration of stem cells in patients with acute myocardial infarction - angiographic follow-up.

BACKGROUND: Even up-to-date reperfusion therapy using primary percutaneous intervention (PCI) in acute myocardial infarction does not result in improvement of the left ventricular (LV) function in all patients. Cellular myoblasty, a novel method using mononuclear bone marrow cells (BMC), can be applied in the infarcted myocardium area to stimulate regeneration and to limit the organ damage. However, the impact of intracoronary BMC administration on the effect of PCI is not clear. AIM: To assess angiographic outcomes in patients with anterior myocardial infarction and LV dysfunction, undergoing intracoronary BMC administration after a successful primary PCI. METHODS: The study group consisted of 40 patients (mean age 56.2 years) with LV ejection fraction below 40%, in whom 20 ml of BMC were administered to the infarct-related artery (IRA) distally to the occlusion. The control group comprised 25 age- and sex-matched patients with similar values of LV ejection fraction undergoing bare metal stenting of IRA without BMC administration. Quantitative coronary angiography was performed 6 months later to assess IRA patency. RESULTS: The reference diameter of the stented artery decreased in the study group from 3.22 +/- 0.28 mm to 3.16 +/- 0.18 mm (p < 0.05) and in the control group from 3.22 +/- 0.31 mm to 3.15 +/- 0.28 mm (p < 0.082); also in the area of the implanted stent the diameter decreased from 3.57 +/- 0.21 mm to 2.96 +/- 0.79 mm in the study group vs. 3.48 +/- 0.22 mm to 3.01 +/- 0.35 mm in the control group. For lumen diameter measured 10 mm distally to the stent, the diameter loss was similar in both groups. In 6 patients from the BMC treated group and in 3 patients from the control group there was asymptomatic lumen reduction > 70% (NS). CONCLUSION: The results of our study show that BMC administration into IRA is safe. The degree of lumen loss in the stent area was larger in the BMC group than in the control group. There was no significant difference in the lumen change distally to the stent; the artery diameter loss in both groups was similar, and the improvement in LV ejection fraction was greater in the BMC-treated group.

Comparison of clinical results and life quality after myocardial infarction therapy with primary percutaneous coronary intervention and fibrinolytic angents.

INTRODUCTION: A correct and early diagnosis of ST-segment elevation myocardial infarction (STEMI) and implementation of treatment with the aim to regain patency of the infarct-related artery is crucial for prognosis and the ability to return to normal activities. OBJECTIVES: The aim of the current analysis was to compare two strategies of STEMI therapy in terms of decreasing the impairment level in patients undergoing treatment, expressed as the time to the return to normal social and professional life. PATIENTS AND METHODS: Two 100-patient groups of patients with STEMI were enrolled into the study. In the first group a fibrinolytic drug was used, while in the other primary percutaneous coronary intervention (PPCI) was performed. The material for the study was collected in the unique transitional period (2001-2002), when the 24-hour call schedule in the catheterization laboratories was introduced in the Ludwik Perzyna Complex Hospital in Kalisz. RESULTS: During the 6-month follow-up mortality in the fibrinolysis group was 18%, and in the PPCI group 1 death (1%). In both groups, there were recurrent chest pain (63% vs. 38.5%, p < 0.0001), the need for nitroglycerin use (73% vs. 37.4%, p < 0.0001), recurrent STEMI (7% vs. 0%, p = 0.02), and recurrent hospitalizations (35% vs. 15.2%, p = 0.003). Marked limitations of activity in family and social life were more commonly observed in the thrombolytic drugs-treated group (p <0.0001). A small percentage of patients who returned to work was observed, however in favor of the PPCI group (20% vs. 38%, p = 0.009). Differences between groups concerning professional status 6 months after STEMI were significant (p = 0.046; chi2). CONCLUSIONS: Treatment of STEMI with PPCI was associated with an earlier return of respondents to health and a significantly smaller limitation of their activity during the 6-month follow-up.