Clinical Article
Does the Admission HB1c Level Have an Impact on the Size of Myocardial Infarction and Residual Viability in Type II Diabetics Surviving Their 1st Myocardial Infarction?
Rayan M, MD.
Background: Hyperglycemia
is strongly associated with increased mortality in type II diabetic patients,
hence, the simple message used to be "The lower, the better." But, the release
of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) data cast
doubt on this and has provoked deliberation ever since. The trial was halted
prematurely because of an increased risk of death in patients who underwent
intensive blood glucose lowering.
Methods: We included 300
patients with type II diabetes who survived their 1st time myocardial infarction
who were kept on the same type of medication Only patients, who received
thrombolytic therapy and were maintained on the same antidiabetic therapy for at
least 3 months before the infarction, were included. Assessment for other risk
factors was done to all included patients such as gender, hypertension, smoking
and dyslipidemia. Infarction size and residual viability were assessed using
rest–Trimetazidine Tc99m Sestamibi SPECT imaging.
Results: We found a
bimodal U shaped behavior of glycated hemoglobin, where the extremely high and
low levels of Hb1c were associated with large infarction size as compared to
middle levels. And that high LDL levels was strongly associated with larger size
of infarction and less viability. Other risk factors did not show a strong
influence on the infarction size or viability.
Conclusions: We concluded
that extremely over or under control of blood glucose ,as reflected by HB1c
level, is associated with increased infarction size and reduced residual
viability and that optimal therapy for diabetics should address not only
glycemic control, but also the coexisting risk factors especially LDL levels.
Keywords: Hb1c, infarction
size, viability, Tc99m Sestamibi
(Heart Mirror J 2009; 3(2): 76-79).