Register
Forgot your password?

Impact of glycemia and diabetes mellitus therapy on coronary microvascular obstruction risk and myocardial infarction prognosis

Authors: Frolov A.A.1 2, Korotina M.A.1 2, Pochinka I.G.1 2, Frolov I.A., 2 Mukhin A.S.1, Sharabrin E.G.1

Company: 1 Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
2 City Clinical Hospital No. 13 of the Nizhny Novgorod Avtozavodsky District, Nizhny Novgorod, Russian Federation

For correspondence:  Sign in or register.

Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2025-19-3-340-351

For citation: Frolov A.A., Korotina M.A., Pochinka I.G., Frolov I.A., Mukhin A.S., Sharabrin E.G. Impact of glycemia and diabetes mellitus therapy on coronary microvascular obstruction risk and myocardial infarction prognosis. Creative Cardiology. 2025; 19 (3): 340–351 (in Russ.). DOI: 10.24022/1997-3187-2025-19-3-340-351

Received / Accepted:  21.05.2025 / 17.07.2025

Keywords: diabetes mellitus glycemia myocardial infarction percutaneous coronary intervention coronary microvascular obstruction no-reflow phenomenon



Subscribe 🔒

 

Abstract

Objective. To assess the role of glycemia indicators and diabetes mellitus (DM) therapy in ST-segment elevation myocardial infarction (STEMI) as risk factors for coronary microvascular obstruction (CMVO) during percutaneous coronary interventions (PCI) and as predictors of long-term mortality.

Material and methods. A single-center study was conducted in patients with type 1 STEMI, PCI, and DM. The study design was combined: a case-control study for identifying CMVO predictors and a cohort study for assessing the impact of the studied indicators on prognosis. CMVO after PCI was defined as blood flow according to TIMI flow grade < 3, or perfusion according to Myocardial Blush Grade < 2, or lack of ST-segment resolution. Analyzed parameters included glucose and glycated hemoglobin on admission, prior DM therapy, and glycemic variability during hospitalization. High glycemic variability was defined as a coefficient of variation (standard deviation to mean glucose level ratio) exceeding 36%. The follow-up period was 12 months.

Results. A total of 161 patients were included: 15 (9.3%) with CMVO and 146 (90.7%) with uncomplicated PCI. Among glycemic and DM therapy indicators, the only predictor of CMVO was glycated hemoglobin level: odds ratio 1.42, 95% confidence interval (CI) 1.04–1.98, p = 0.03 (logistic regression). During hospitalization, 11 (6.8%) patients died, and after discharge, another 12 (7.5%) died, totaling 23 (14.3%). In the overall patient cohort, high glycemic variability was a predictor of mortality: hazard ratio 2.75, 95% CI 1.19–6.30, p = 0.02 (Cox regression). Survival probability was 0.71 (95% CI 0.59–0.87) with high glycemic variability and 0.89 (95% CI 0.83–0.96) with low variability, p < 0.001 (log-rank test).

Conclusion. In patients with STEMI and DM, elevated glycated hemoglobin at the time of PCI is a risk factor for CMVO, while high glycemic variability during hospitalization leads to worse survival and is a predictor of long-term mortality. Prior DM therapy does not influence CMVO development.

References

  1. Gilyarov M.Yu., Ivanov I.I., Konstantinova E.V., Raschetnova N.I., Shostak N.A. No-reflow phenomenon and reperfusion injury. Mechanisms and treatment. Klinitsist. 2021; 15 (1–4): 10–19 (in Russ.). DOI: 10.17650/1818-8338-2021-15-1-4-K645
  2. Zhuravlev A.S., Azarov A.V., Semitko S.P., Ioseliani D.G. The no-reflow phenomenon during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction due to massive coronary thrombosis. Pathogenesis and predictors of no-reflow. Kardiologiia. 2021; 61 (2): 99–105 (in Russ.). DOI: 10.18087/cardio.2021.2.n1175
  3. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020; 25(11): 4103 (in Russ.). DOI: 10.15829/1560-4071-2020-4103
  4. Tasar O., Karabay A.K., Oduncu V., Kirma C. Predictors and outcomes of no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron. Artery Dis. 2019; 30 (4): 270–276. DOI: 10.1097/mca.0000000000000726
  5. Kaur G., Baghdasaryan P., Natarajan B., Sethi P., Mukherjee A., Varadarajan P. et al. Pathophysiology, diagnosis, and management of coronary no-reflow phenomenon. Int. J. Angiol. 2021; 30 (1): 15–21. DOI: 10.1055/s-0041-1725979
  6. Khalfallah M., Maria D.A., Allaithy A. Impact of stress hyperglycemia on no-reflow phenomenon in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Glob. Heart. 2022; 17 (1): 23. DOI: 10.5334/gh.1111
  7. Zhao Z., Wang L., Gao W., Hu F., Zhang J., Ren Y. et al. A central catecholaminergic circuit controls blood glucose levels during stress. Neuron. 2017; 95 (1): 138–152.e5. DOI: 10.1016/j.neuron.2017.05.031
  8. Sun B., Luo Z., Zhou J. Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications. Cardiovasc. Diabetol. 2021; 20 (1): 9. DOI: 10.1186/s12933-020-01200-7
  9. Chai T.Y., McLean M., Wong V.W., Cheung N.W. Glycaemic variability is associated with adverse cardiovascular outcomes in patients hospitalised with an acute myocardial infarction. J. Clin. Transl. Endocrinol. 2019; 18: 100203. DOI: 10.1016/j.jcte.2019.100203
  10. Acute myocardial infarction with ST segment elevation of the electrocardiogram. Clinical guidelines 2020. Russian Society of Cardiology, Association of Cardiovascular Surgeons of Russia. Russian Journal of Cardiology. 2020; 25 (11): 4103 (in Russ.). DOI: 10.15829/1560-4071-2020-4103
  11. Mueller H.S., Dyer A., Greenberg M.A. The TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N. Engl. J. Med. 1985; 312 (14): 932–936. DOI: 10.1056/nejm198504043121437
  12. Van 't Hof A.W., Liem A., Suryapranata H., Hoorntje J.C., de Boer M.J., Zijlstra F. Myocardial Infarction Study Group. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Circulation. 1998; 97 (23): 2302–2306. DOI: 10.1161/01.cir.97.23.2302
  13. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron. Clin. Pract. 2012; 120 (4): c179–184. DOI: 10.1159/000339789
  14. Dedov I.I., Shestakova M.V., Mayorov A.Yu. (Eds.) Standards of specialized diabetes care. 10th edition. Diabetes Mellitus. 2021; 24 (1S): 1–148 (in Russ.). DOI: 10.14341/DM12802
  15. Korotina M.A., Pochinka I.G., Strongin L.G. Use of metformin in patients with type 2 diabetes and acute myocardial infarction: safety and impact on glycemic control. Problems of Endocrinology. 2023; 69 (1): 28–35 (in Russ.). DOI: 10.14341/probl13170
  16. Battelino T., Danne T., Bergenstal R.M., Amiel S.A., Beck R., Biester T. et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019; 42 (8): 1593–1603. DOI: 10.2337/dci19-0028
  17. Korotina M.A., Pochinka I.G., Strongin L.G. Differentiated approach to glycemic management in type 2 diabetic patients during inpatient treatment of acute myocardial infarction: glycemic control and long-term prognosis. Diabetes Mellitus. 2023; 26 (6): 556–565 (in Russ.). DOI: 10.14341/DM13013
  18. Asfandiyarova N.S. A review of mortality in type 2 diabetes mellitus. Diabetes Mellitus. 2015; 18 (4): 12–21 (in Russ.). DOI: 10.14341/DM6846
  19. Kaur R., Kaur M., Singh J. Endothelial dysfunction and platelet hyperactivity in type 2 diabetes mellitus: molecular insights and therapeutic strategies. Cardiovasc. Diabetol. 2018; 17 (1): 121. DOI: 10.1186/s12933-018-0763-3
  20. Bessonov I.S., Kuznetsov V.A., Gorbatenko E.A., Zyrianov I.P., Sapozhnikov S.S., Dyakova A.O. Direct stenting in patients with ST-elevation myocardial infarction and hyperglycemia. Patologiya Krovoobrashcheniya i Kardiokhirurgiya. 2019; 23 (1 Suppl. 1): S44–S51 (in Russ.). DOI: 10.21688/1681-3472-2019-1S-S44-S51
  21. Wang J.W., Zhou Z.Q., Chen Y.D., Wang C.H., Zhu X.L. A risk score for no reflow in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention. Clin. Cardiol. 2015; 38 (4): 208–215. DOI: 10.1002/clc.22376
  22. Xiao Y., Fu X., Wang Y., Wu Y., Wang W., Zhang Q. Development and validation of risk nomogram model predicting coronary microvascular obstruction in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous catheterization. Med. Sci. Monit. 2019; 25: 5864–5877. DOI: 10.12659/msm.915960
  23. Popyhova E.B., Stepanova T.V., Lagutina D.D., Kiriyazi T.S., Ivanov A.N. The role of diabetes in the onset and development of endothelial dysfunction. Problems of Endocrinology. 2020; 66 (1): 47–55 (in Russ.). DOI: 10.14341/probl12212
  24. Lazzeri C., Valente S., Chiostri M., D'Alfonso M.G., Gensini G.F. Clinical significance of glycated hemoglobin in the acute phase of ST elevation myocardial infarction. World J. Cardiol. 2014; 6 (4): 140–147. DOI: 10.4330/wjc.v6.i4.140
  25. Mohamed Farag I.A., Hashem A.R., Elias R.R. Glycated hemoglobin as a predictor of no reflow in diabetic patients with ST segment elevation myocardial infarction managed by primary percutaneous coronary intervention. QJM Intern. J. Med. 2024; 117 (Suppl. 2): hcae175.129. DOI: 10.1093/qjmed/hcae175.129
  26. Iwakura K., Ito H., Ikushima M., Kawano S., Okamura A., Asano K. et al. Association between hyperglycemia and the no-reflow phenomenon in patients with acute myocardial infarction. J. Am. Coll. Cardiol. 2003; 41 (1): 1–7. DOI: 10.1016/s0735-1097(02)02626-8
  27. Ceriello A., Esposito K., Piconi L., Ihnat M.A., Thorpe J.E., Testa R. et al. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes. 2008; 57 (5): 1349–1354. DOI: 10.2337/db08–0063
  28. Xia J., Zhang J., Chang J., Tian Y., Li J., Zhang B. et al. The effects of glycaemic variability on intimal hyperplasia and plaque stability after stenting via autophagy-mediated G3BP1/NLRP3 inflammasome. Ann. Transl. Med. 2020; 8 (21): 1388. DOI: 10.21037/atm-20–4818
  29. Gerbaud E., Darier R., Montaudon M., Beauvieux M.C., Coffin-Boutreux C., Coste P. et al. Glycemic variability is a powerful independent predictive factor of midterm major adverse cardiac events in patients with diabetes with acute coronary syndrome. Diabetes Care. 2019; 42(4): 674–681. DOI: 10.2337/dc18–2047
  30. Yang C.D., Shen Y., Ding F.H., Yang Z.K., Hu J., Shen W.F. et al. Visit-to-visit fasting plasma glucose variability is associated with left ventricular adverse remodeling in diabetic patients with STEMI. Cardiovasc. Diabetol. 2020; 19 (1): 131. DOI: 10.1186/s12933-020-01112-6
  31. Tsuchida K., Nishida K., Soda S., Akiyama T., Hakamata T., Sudo K. et al. Impact of glycemic variability on myocardial infarct size in patients with ST-segment elevation myocardial infarction: quantitative assessment of left ventricular wall motion severity. Cardiovasc. Interv. Ther. 2019; 34 (2): 122–130. DOI: 10.1007/s12928–018–0531-z

About Authors

  • Aleksey A. Frolov, Cand. Med. Sci., Associate Professor of the Hospital Surgery Chair named after B.A. Korolev, Endovascular Surgeon; ORCID
  • Mariya A. Korotina, Cand. Med. Sci., Assistant Professor, Cardiologist; ORCID
  • Ilya G. Pochinka, Dr. Med. Sci., Associate Professor, Chief of the Endocrinology and Internal Medicine Chair, Head of the Cardiology Department; ORCID
  • Igor A. Frolov, Endovascular Surgeon; ORCID
  • Aleksey S. Mukhin, Dr. Med. Sci., Professor, Chief of the Hospital Surgery Chair named after B.A. Korolev; ORCID
  • Evgeniy G. Sharabrin, Dr. Med. Sci., Professor of the Endovascular Surgery Chair; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by