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1 Student t-test P SPSS (EF< ) Stress Hyperglycemia

2 ( 1 ACC- 2 AHA) QT Ischemic preconditioning CPK CCU SPSS student T-test 1 American College of Cardiology 2 American Heart Association

3 2 P Mean ± SD Mean ± SD P> P mg/dl mg/dl (EF<50%) PR P PR (EF<50%) P-R EF<50%

4 Stress Hyperglycemia (no-reflow) Ischemic preconditioning CCU QT A VII

5 References 1. Richers W, Nesto S. Capter 51 In: Braunwald E. Heart Disease, Textbook of Cardiovascular Medicine. 7th ed, London: W.B. Saunders Co. 2005; Heinrich R, Schelbert M, Chapter 90 In: Valentir Fuster R. Wayne A. The Heart Hurst 11th ed, 2004; Alvinc P. Chapter 338. In: Kasper D, Braunwald E, Fauci AS, et al. Harrison's Principles of Internal Medicine. 16th ed, New York: McGraw-Hill publication. 2005; Silvio E, Inzucchi E. Chapter 248. In: Goldman L, Ausiello D. Cecil Textbook of Medicine. 22th ed, United State of America: W.B. Saunders Co. 2004; Capes SE, Hunt D, Malmberg K. Stress Hyperglycemia and Increased Risk of death after myocardial infarction in patient with and without diabetes: a Systemic Overview. Lancet. 2003; 355: Yudkin JS, Oswald GA. Stress Hyperglycemia and cause of death in non- diabetic patients with Myocardial Infarction. Br Med J. 1987; 294: Bellodi G, Manicardi V, Malavasi V, et al: Hyperglycemia and prognosis of acute myocardial infarction in patient without diabetes mellitus. Am. J. Cardiology. 1989; 64: Christophe B, Pierre V, Olivier T, et al: Stress Hyperglycemia is an independent predictor of left ventricular remodeling after first anterior MI in non diabetic patients. European Heart Journal. 2007; 28(5): Kersten JR, Schmeling TJ, Ort T, et al: Acute Hyperglycemia abolishes ischemia preconditioning in vivo. Am. J. Physiol. 275: Ross R. Atherosclerisis, An inflammatory disease. N. Eng. J Med. 1999; 340:

6 11. Esposito K, Nappo F, Marfella R, et al. Inflammatory cytokines concentrations are acutely increased by hyperglycemia in human. Role of oxidative stress. Circulation. 2002; 106: Ceriello A. Acute hyperglycemia a (new) risk factor during Myocardial infarction. European Heart Journal. 2005;26: Gokhroo R, Mittal SR. Electrocardiographic correlates of hyperglycemia in acute myocardial infarction. Int J Cardiol. 1989; 22: Marfella R, Nappo F, Angelis D, et al. the effect of acute hyperglycemia on QTc duration in healthy man. Diabetologia. 2000; 43: D'amico M, Marfvella R, Nappo F, et al. High glucose induces ventricular instability and increases vasomotor tone in rats. Diabetologia. 2001; 44: Ishihara M, Inoue I, Kawagoe T, et al. Impact of acute hyperglycemia first anterior wall acute myocardial infarction. Am Heart J. 2003; 146: Iwakura K, Ito H, Ikushima M, et al. Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction. J Am Coll Cardiol. 2003; 41: Baele G, Mussche M, Vermeire P. Serum fibrin- fibrinogen degradation products in acute myocardial infarction. Lancet. 1972; 1: Chandler AB, Chapman I, Erhardt LR, et al. Coronary thrombosis in myocardial infarction. Report of a workshop on the role of coronary thrombosis in the pathogenesis of acute myocartdial infarction. Am J Cardiol.1974; 34: Oswald GA, Smith CC, Delamothe AP, et al. Raised concentrations of glucose and adrenaline and increased in vivo platelet activation after myocardial infarction. Br Heart J. 1988; 59: Jones RL, Peterson CM. Reduced fibrinogen survival in diabetes mellitus a reversible phenomenon. J Clin Invest. 1979; 63: Ceriello A, Giugliano D, Quatrato A, et al. Hyperglycemia may determine fibrinopeptide A plasma level increase in humans. Metabolism. 1989; 38: Mulvihill NT, Foley JB. Inflammation in acute coronary syndromes. Heart 2002; 87: Marfella R, Siniscalchi M, Esposite K, et al. Effects of stress hyperglycemia on acute myocardial infarction: role of inflammatory immune process in functional cardiac outcome. Diabetes Care. 2003; 26: Marfella R, Esposito K, Giunta R, et al. Circulating adhesion molecules in humans: role of hyperglycemia and hyperinsulinemia. Circulation. 2000; 101:

7 26. De Caterina R. Endothelial dysfunctions: common denominators in vascular disease. Curr Opin Lipidol. 2000; 11: Valgimigli M, Merli E, Malagutte P, et al. Endothelial dysfunction in acute and chronic coronary syndromes: evidence for a pathogenetic rle of oxidative stress. Arch Biochem Biophys. 2003; 420: Heinecke JW. Oxidative stress: new approaches to diagnosis and prognosis in atherosclerosis. Am J Cardiol. 2003; 91 (suppl): 12A-16A. 29. Ceriello A. Acute hyperglycemial and oxidative stress generation. Diabet Med. 1997; 14: S45- S Foo K, Cooper J, Deaner A, rt al. A single serum glucose measurement predicts adverse outcomes across the whole range of acute coronary syndromes. Heart. 2003; 89: Meire JJ, Deifuss S, Klamann A, et al. Plasma glucose at hospital admission and previous metabolic control determine myocardial infarct size and survival in patients with and without type 2 diabetes: the Langendreer Myocardial Infarction and Blood Glucose in Diabetic Patients. Diabets Care. 2005; 28:

8 Correlation between Stress Hyperglycemia and Short-Term Prognosis in non Diabetic Patients with Acute Myocardial Infarction Rafighdoust Amirhossein, MD*; Rakhshani Abdolali, MD**; Komeili Gholamreza *** Background: Abnormal hyperglycemia is a common finding in early phase of acute myocardial infarction that is named as stress hyperglycemia. In this study we have evaluated primary blood sugar of non-diabetic patients with acute myocardial infarction at the time of admission to compare the early complications between patients with high or normal blood sugar. We aimed to find any relation between primary blood sugar and post MI complication rate. Materials and Methods: One hundred non-diabetic patients with acute myocardial infarction who were referred to heart emergency ward of Imam Reza Hospital (Mashhad, Iran) were included in this study. According to primary blood glucose level, 50 patients with blood glucose > 126 mg/dl were compared with 50 patients with normal blood glucose level. All patients were evaluated during hospitalization and daily clinical examinations laboratory tests, and routine non-invasive assessments were done. The results were analyzed by SPSS software and the level of signification difference was described as p<0.05. Results: Sinus tachycardia, atrial fibrillation, bundle branch block, ventricular extrasystole, prolonged PR-interval and heart failure according to Klip classification and also according to echocardiographic index (EF<50) were statistically significant and more common in hyperglycemic patients (0.05). Thromboembolic and mechanical complications (papillary muscle dysfunction), pericarditis, phlebitis and angina were also more common in hyperglycemic group although the differences were not significant statistically. Conclusion: It seems that high rate of early complications in non-diabetic patients with acute myocardial infarction is directly related to primary hyperglycemia (stress hyperglycemia). KEYWORDS: Primary blood sugar, Stress hyperglycemia, Acute myocardial infarction, Prognosis Received: 25/Sep /2008 Accepted: 28/Feb /2009 *MD, Dept of Internal diseases, Zahedan University of Medical Sciences and Health Services, Zahedan, Iran. **Assistant Prof, Dept of cardiology, Zahedan University of Medical Sciences and Health Services, Zahedan, Iran. ***Associated Prof, Dept of Physiology, Zahedan University of Medical Sciences and Health Services, Zahedan, Iran.

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