ABSTRACT
In patients with acute myocardial infarction, glucose metabolism is altered and acute hyperglycemia on admission is common regardless of diabetes status. The development of coronary collateral is heterogeneous among individuals with coronary artery disease. In this study, we aimed to investigate whether glucose value on admission is associated with collateral flow in ST-elevation myocardial infarction (STEMI) patients. We retrospectively evaluated 190 consecutive patients with a diagnosis of first STEMI within 12 hours of onset of chest pain. Coronary collateral development was graded according to Rentrop classification. Rentrop 0-1 was graded as poor collateral development, and Rentrop 2-3 was graded as good collateral development. Admission glucose was measured and compared between two groups. Mean admission glucose level was 173.0 ± 80.1 mg/dl in study population. Forty-five (23.7%) patients had good collateral development, and 145 (76.3%) patients had poor collateral development. There were no statistically significant differences in demographic characteristics between two groups. Three-vessel disease was more common in patients with good collateral development (p=0.026). Mean admission glucose level was higher in patients with poor collateral than good collateral (180.6 ± 84.9 mg/dl versus 148.7 ± 56.6 mg/dl, resp., p=0.008). In univariate analysis, higher admission glucose was associated with poor collateral development, but multivariate logistic regression analysis revealed a borderline result (odds ratio 0.994, 95% CI 0.989-1.000, p=0.049). Our results suggest that elevated glucose on admission may have a role in the attenuation of coronary collateral blood flow in acute myocardial infarction. Further studies are needed to validate our results.
ABSTRACT
OBJECTIVE: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is more effective at estimating glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) equation, particularly in patients with mildly impaired renal function. Recent studies have demonstrated, using the Cockroft-Gault and MDRD formulas, a significant correlation between slow coronary flow (SCF) and normal to mildly impaired renal function. However, these studies had some limitations. The aim of the present study was to investigate the relationship between SCF and normal to mildly impaired renal function using the CKD-EPI equation. METHODS: A total of 370 patients were included, 172 with normal coronary flow (NCF) and 198 with SCF. All participants had normal to mildly impaired renal function. Both the CKD-EPI and MDRD formulas were used to calculated estimated glomerular filtration rate (eGFR), which was compared between groups. RESULTS: No significant difference in mean values of eGFR was found between the NCF and SCF groups (CKD-EPI: 92.9±14.7 vs 92.7±14.2, p=0.72; MDRD: 89.5±19.5 vs 88.2±17.0, p=0.70, respectively). Among patients with eGFR(MDRD) ≥90 mL/min/1.73 m2, mean eGFR levels were lower among patients with SCF (107.0±12.7 vs 102.7±10.0, p=0.02). CONCLUSION: No correlation was found between SCF and normal to mildly impaired renal function.
