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

Cardiovasc Diabetol. 2021 Feb 2;20(1):33. doi: 10.1186/s12933-021-01222-9.

Abstract

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.

Keywords: Hyperglycemia; Infarct size; Inflammation; MINOCA; Obstructive acute myocardial infarction.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Glucose / metabolism*
  • Blood Platelets
  • C-Reactive Protein / metabolism
  • Coronary Angiography
  • Female
  • Heart Disease Risk Factors
  • Humans
  • Hyperglycemia / blood*
  • Hyperglycemia / diagnosis
  • Hyperglycemia / epidemiology
  • Inflammation / blood*
  • Inflammation / diagnosis
  • Inflammation / epidemiology
  • Inflammation Mediators / blood*
  • Italy / epidemiology
  • Lymphocyte Count
  • Lymphocytes
  • Male
  • Middle Aged
  • Myocardial Infarction / blood*
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / physiopathology
  • Myocardium / pathology*
  • Neutrophils
  • Platelet Count
  • Predictive Value of Tests
  • Risk Assessment
  • Stroke Volume
  • Troponin I / blood
  • Ventricular Function, Left

Substances

  • Biomarkers
  • Blood Glucose
  • Inflammation Mediators
  • Troponin I
  • C-Reactive Protein