Open Access Highly Accessed Original investigation

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Danijela Trifunovic12*, Sanja Stankovic3, Dragana Sobic-Saranovic24, Jelena Marinkovic5, Marija Petrovic1, Dejan Orlic12, Branko Beleslin12, Marko Banovic12, Bosiljka Vujisic-Tesic12, Milan Petrovic12, Ivana Nedeljkovic12, Jelena Stepanovic12, Ana Djordjevic-Dikic12, Milorad Tesic1, Nina Djukanovic1, Olga Petrovic1, Olga Vasovic6, Emilija Nestorovic1, Jelena Kostic1, Arsen Ristic12 and Miodrag Ostojic67

Author Affiliations

1 Department of Cardiology, Clinical Centre of Serbia, Ul. Koste Todorovica 8, 11000 Belgrade, Serbia

2 School of Medicine, University of Belgrade, Belgrade, Serbia

3 Center for Medical Biochemistry, Clinical Centre of Serbia, School of Pharmacy, University of Belgrade, Belgrade, Serbia

4 Department of Nuclear medicine, Clinical Centre of Serbia, Belgrade, Serbia

5 Institute of Medical Statistics and Informatics, School of Medicine, University of Belgrade, Belgrade, Serbia

6 Institute for Gerontology and Palliative Care, Belgrade, Serbia

7 Serbian Academy of Sciences and Arts, University of Belgrade, Belgrade, Serbia

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Cardiovascular Diabetology 2014, 13:73  doi:10.1186/1475-2840-13-73

Published: 5 April 2014

Abstract

Background

Insulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI).

Methods

In 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2nd and 7th day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2nd day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices.

Results

IR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (p = 0.001) and day 7 (p < 0.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (r = 0.331), whereas both HOMA indices correlated well with CFR (r = -0.331 to -0.386) (p < 0.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2 mm (OR 11.70, 95% CI 2.46-55.51, p = 0.002) and CFR < 2 (OR = 5.98, 95% CI 1.88-19.03, p = 0.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, p = 0.026).

Conclusion

IR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size.

Keywords:
Insulin resistance; Acute myocardial infarction; ST-E resolution; Coronary microcirculation; Infarct size