[Hyperglycemia at admission and outcome in elderly patients with acute ST segment elevation myocardial infarction underwent primary percutaneous coronary intervention].

OBJECTIVE: To investigate the association between hyperglycemia and outcome in elderly patients with acute ST segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI). METHODS: This retrospective analysis was performed on 284 elderly patients (age > or = 60 years) with acute STEMI underwent primary PCI between January 2000 to April 2004 in our department. Patients were divided into 3 groups according to the level of blood glucose on admission: group A, < 7.8 mmol/L; group B, 7.8 - 10.9 mmol/L; group C, > or = 11.0 mmol/L. RESULTS: (1) The proportion of female in group B and group C was greater than that of group A (33.3% vs. 26.5%, P < 0.01; 40.2% vs. 26.5%, P < 0.01). The hospital stay time of group B and group C was significantly longer than that of group A (16.0 days vs. 13.9 days, P < 0.05; 16.6 days vs. 13.9 days, P < 0.05). There were more patients with history of hypertension in group C than that in group A (72.1% vs. 54.9%, P < 0.01). (2) After PCI, the proportion of patients with TIMI myocardial perfusion grade (TMPG) 0-1 in group B and C was greater than that of group A (22.6% vs. 13.3%, P < 0.05; 34.1% vs. 13.3%, P < 0.05). The proportion of patients with TMPG 3 in group B and C was less than that in group A (74.3% vs. 84.4%, P < 0.05; 57.6% vs. 84.4%, P < 0.05). The complication rate of PCI was significantly higher in group C than in group A (42.5% vs. 20.6%, P < 0.01) and group B (42.5% vs. 26.6%, P < 0.01). IABP use was significantly more in group C than that in group A (19.5% vs. 4.9%, P < 0.01) and group B (19.5% vs. 6.4%, P < 0.01). (3) There were more patients with grade of Killip class > or = 2 in group C than that in group A (44.8% vs. 23.5%, P < 0.01) and group B (44.8% vs. 27.7%, P < 0.01). The in-hospital mortality rate (8.0% vs. 1.1%, P < 0.05) and one-year mortality rate (18.7% vs. 3.4%, P < 0.05) of group C were significantly higher than those in group A. CONCLUSION: Hyperglycemia at admission was associated with poor tissue perfusion, cardiac function and prognosis in elderly patients with acute STEMI underwent primary PCI.

MTAP and CDKN2B genes are associated with myocardial infarction in Chinese Hans.

OBJECTIVES: To investigate the association between cyclin-dependent kinase inhibitor 2A (CDKN2A) gene, cyclin-dependent kinase inhibitor 2B (CDKN2B) gene, and methylthioadenosine phosphorylase (MTAP) gene and myocardial infarction (MI) in Chinese Hans. DESIGN AND METHODS: A total of 432 patients with MI and 430 controls were included in the study. Nine polymorphisms in the MTAP gene, two polymorphisms in the CDKN2A gene, and two polymorphisms in the CDKN2B gene were selected using a tagging single nucleotide polymorphism (tSNP) strategy. RESULTS: We observed that rs7027989 in the MTAP gene, and rs3217992 and rs1063192 in the CDKN2B gene were significantly associated with MI in male subjects. For rs7027989 and rs3217992, male subjects with the AA or AG genotypes had 1.26-fold and 1.24-fold increased risk of MI, respectively, compared with those with the GG genotype. For rs1063192, the G allele was associated with a reduced risk of MI with a per-allele OR of 0.71 in male subjects. The risk of rs7027989 and rs1063192 remained significant after adjusting for covariates. CONCLUSIONS: This study demonstrates for the first time that polymorphisms in CDKN2B and MTAP gene may influence the risk of MI in Chinese.

Relation of hyperglycemia to ST-segment resolution after primary percutaneous coronary intervention for acute myocardial infarction.

BACKGROUND: Hyperglycemia has been shown to be a powerful predictor of poor outcome after ST-segment elevation myocardial infarction (STEMI). This study aimed to evaluate the effect of admission glucose on microvascular flow after successful primary percutaneous coronary intervention (PCI) in patients with STEMI. METHODS: Successful primary PCI was performed in 267 patients with STEMI. The maximum ST elevation of single electrocardiogram (ECG) lead before and 60 minutes after PCI was measured, and patients were then divided into 3 groups according to the degree of ST-segment resolution (STR): absent (<30%), partial (30% to 70%) or complete (> or =70%). RESULTS: Of the 267 patients, 48 (18.0%) had absent STR, 137 (51.3%) experienced partial STR, and 82 (30.7%) had complete STR. The degree of STR decreased with increasing admission glucose levels (P=0.032), and patients with hyperglycemia (serum glucose level > or =11 mmol/L) were more likely to have absent STR (P=0.001). Moreover,hyperglycemia was an independent predictor of incomplete STR (odds ratio, 1.870; 95% confidence interval, 1.038 to 3.371, P=0.037). CONCLUSIONS: Hyperglycemia on admission is associated with abnormal coronary microvascular reperfusion in patients with STEMI after successful primary PCI, which may contribute, at least in part, to the poor outcomes in these patients.

[Effect of IGF-1 on PI3K/PTEN signal pathway in vascular smooth muscle cell].

AIM: To investigate the cellular signal transduction pathway of vascular smooth muscle cell (VSMC) proliferation stimulated by insulin-like growth factor-1 (IGF-1). METHODS: Rabbit aortic VSMCs was cultured in 3 groups. Cell proliferating ability was determined by measuring cell number and mitochondrial dehydrogenase (MD) activity (MTT assay). Wortmannin (WT), the specific inhibitor of phosphatidylinositol 3-kinase (PI3K), was used to evaluate indirectly the possible involvement of PI3K. Western blotting was used to detect the protein expression of phosphatase PTEN. Diphosphate action of PTEN on its specific substrate diC16PIP3 was measured by green reagent method. RESULTS: IGF-1 (100 microg/L) increased cell number and MD activity by 2.8-3.8 fold. WT markedly inhibited VSMC proliferation and completely abolished the above effects of IGF-1. IGF-1 inhibited PTEN activity in a concentration-(10-100 microg/L) and time--(3 min-24 h) dependent manner (P < 0.01). CONCLUSION: IGF-1 increases VSM proliferation by increasing PI3K activity and inhibiting PTEN activity.