Won Yong Kim

Impact of acute hyperglycemia on myocardial infarct size, area at risk and salvage in patients with ST elevation myocardial infarction and the association with exenatide treatment - results from a randomized study

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  • Jacob Thomsen Lønborg, Institut for Klinisk Medicin, Denmark
  • Niels Grove Vejlstrup, Ph.d.-studienævnet for Medicin, Denmark
  • Henning Skov Kelbæk, Institut for Klinisk Medicin, Denmark
  • Lars Gregers Nepper-Christensen, Afd. for Undervisning, Denmark
  • Steffen Helqvist, Institut for Klinisk Medicin, Denmark
  • Erik Jørgensen, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
  • Lene Holmvang, Institut for Klinisk Medicin, Denmark
  • Kari Saunamäki
  • ,
  • Hans Erik Bøtker
  • Won Yong Kim
  • Peter Clemmensen, Institut for Klinisk Medicin, Denmark
  • Marek Treiman, Afd. for Hjerte- og Kredsløbsforskning, Denmark
  • Thomas Engstrøm, Ph.d.-studienævnet for Medicin, Denmark
Hyperglycemia upon admission in ST-segment elevation myocardial infarction (STEMI) patients occurs frequently and is associated with adverse outcome. It is however unsettled whether elevated blood glucose is the cause or consequence of increased myocardial damage. In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this sub-study were to evaluate the association between hyperglycemia and infarct size, myocardial salvage and area-at-risk, and to assess the interaction between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area-at-risk and infarct size compared to patients with normoglycemia, but the salvage index and infarct size adjusting for area-at-risk did not differ between the groups. Treatment with exenatide resulted in increased salvage index both among patients with normoglycemia and hyperglycemia. Thus, we conclude that the association between hyperglycemia upon admission and infarct size in STEMI patients is a consequence of a larger myocardial area-at-risk but not on a reduction in myocardial salvage. Also, cardioprotection by exenatide treatment is independent of admission glucose levels. Thus, hyperglycemia does not influence the effect of the reperfusion treatment but rather represents a surrogate marker for the severity of myocardium at risk and injury.
Original languageEnglish
JournalDiabetes
Pages (from-to)2474-2485
Number of pages11
ISSN0012-1797
DOIs
Publication statusPublished - 28 Feb 2014

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