الفهرس 
Myocardial Infarction and Myocardial InjuryOnly 14 pages are availabe for public view
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Abstract
egardless of the diabetic status of patients with coronary artery disease, hyperglycemia is adversely associated with cardiovascular events.
Data from human and animal studies supporting a direct pro-atherogenic role of hyperglycemia in vascular cells are not as strong as those for insulin resistance, but there is suggestive evidence that high glucose is atherogenic, particularly at the level of the arterial endothelium. Hyperglycemia induces a large number of alterations at the cellular level of vascular tissue that potentially accelerate the atherosclerotic process.
Because it is not clear whether cardiac events are more likely to be associated with hyperglycemia than with euglycemia, we set out to evaluate the relationship between elevated pre-procedural blood glucose levels and myocardial injury in patients who have undergone elective PCI
This current study included 110 patients who presented to Ain Shams university hospitals scheduled for elective percutaneous coronary intervention. divided into two equal groups 55 euglycemic patients and 55 hyperglycemic patients. during the period from January 2020 to August 2020.
Blood glucose level was measured immediately before the procedure according which patients were classified into two groups: the first group included euglycemic patients with blood glucose level ranged from 81 to 125 mg/dL and the other group included hyperglycemic patients with blood glucose level ≥126 mg/dL.
Blood samples for cardiac troponin were obtained before the procedure and 12 hours after the procedure. Using Troponin(I) level which normal reference ranged from (0.02-0.06 ng/L(.
Peri-procedural myocardial injury was diagnosed in the presence of elevated cardiac troponin values with at least one value above the 99th percentile upper reference limit.
Peri-procedural myocardial infarction (MI) was defined by an elevation of cTn values > 5 times of the 99th percentile URL in patients with normal baseline values. In addition with at least one of the following:
New ischaemic ECG changes.
Development of new pathological Q waves.
Imaging evidence of loss of viable myocardium.
Angiographic findings consistent with a procedural flow-limiting complication such as coronary dissection, occlusion of a major epicardial artery or graft, side-branch occlusion-thrombus, disruption of collateral flow or distal embolization.
According to the results of the current study we concluded that there was statistically significant difference between the two groups regarding incidence of both myocardial infarction and myocardial injury, both being higher among the hyperglycemic group.
All five patients who had myocardial infarction belonged to the hyperglycemic group (P-value: 0.022).
23 patients with myocardial injury belonged to the hyperglycemic group while only 7 patients with myocardial injury belonged to the euglycemic group (P-value: 0.001).
Through those data, we recommend adequate pre-procedural blood glucose level control for patients undergoing elective percutaneous coronary intervention in order to decrease the incidence of both peri-procedural myocardial injury and myocardial infarction.