Circulation: Cardiovascular Interventions Editors’ Picks
Most Important Articles in ST-Elevation–Myocardial Infarction
Prognostic Impact of Hyperglycemia in Nondiabetic and Diabetic Patients With ST-Elevation–Myocardial Infarction: Insights From Contrast-Enhanced Magnetic Resonance Imaging
Summary: Previous studies have suggested that hyperglycemia on admission is a risk factor for increased mortality in patients with acute ST-elevation–myocardial infarction (STEMI). However, data regarding the relationship between hyperglycemia and myocardial damage in STEMI are scarce. This largest cardiac magnetic resonance study to date evaluating the relationship of diabetes mellitus status and elevated glucose levels on admission on myocardial damage in STEMI patients reperfused by primary percutaneous coronary intervention has 2 essential findings: (1) STEMI patients with pre-existing diabetes mellitus are at greater risk for major adverse cardiovascular events despite having similar infarct sizes and extent of reperfusion injury than patients without known diabetes mellitus. (2) Elevated glucose levels on admission are associated with greater myocardial damage (larger infarcts, more pronounced reperfusion injury, left ventricular dysfunction) and an increased risk of clinical events at long-term follow-up. However, hyperglycemia was a stronger indicator of myocardial injury in STEMI patients without previously recognized diabetes mellitus than in those with established diabetes mellitus. Thus, the authors’ study confirms and expands previous findings by demonstrating that the amount of myocardial injury does not explain the substantially higher mortality rates in diabetic patients with STEMI. Moreover, the authors could demonstrate that the relationship between hyperglycemia and myocardial damage is different in STEMI patients with and without known diabetes mellitus.
Conclusions: The higher mortality rate in diabetic versus nondiabetic STEMI patients is not explained by more pronounced myocardial damage. Hyperglycemia on admission is associated with greater myocardial injury and an increased risk of major adverse cardiovascular events at long-term follow-up. However, hyperglycemia has a stronger relationship to myocardial injury in nondiabetic compared with diabetic patients.1
Polyvascular Disease and Long-Term Cardiovascular Outcomes in Older Patients With Non–ST-Segment–Elevation Myocardial Infarction
Summary: Prior studies have shown that patients with non–ST-segment–elevation myocardial infarction and polyvascular disease (prior peripheral arterial disease, cerebrovascular disease, or both in addition to coronary artery disease) have …