Journal Article

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

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

2021

Overview

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.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Aged / Aged, 80 and over / Angiography / Angiology / Biomarkers / Biomarkers - blood / Blood Glucose - metabolism / Blood Platelets / C-reactive protein / C-Reactive Protein - metabolism / Calcium-binding protein / Cardiology / Cardiovascular disease / Coronary Angiography / Diabetes / Female / Heart / Heart Disease Risk Factors / Humans / Hyperglycemia / Hyperglycemia - blood / Hyperglycemia - diagnosis / Hyperglycemia - epidemiology / Infarct size / Inflammation / Inflammation - blood / Inflammation - diagnosis / Inflammation - epidemiology / Inflammation Mediators - blood / Italy - epidemiology / Leukocytes (neutrophilic) / Lymphocyte Count / Lymphocytes / Male / Medical imaging / Medicine / Medicine & Public Health / Middle Aged / MINOCA / Myocardial infarction / Myocardial Infarction - blood / Myocardial Infarction - diagnostic imaging / Myocardial Infarction - epidemiology / Myocardial Infarction - physiopathology / Myocardium - pathology / Neutrophils / Obstructive acute myocardial infarction / Original Investigation / Platelet Count / Platelets / Population studies / Predictive Value of Tests / Risk Assessment / Stroke Volume / Troponin / Troponin I / Troponin I - blood / Ventricle / Ventricular Function, Left