Acute hyperglycemia and spontaneous reperfusion in acute myocardial infarction 

Background: Spontaneous reperfusion (SR) may occur in patients with ST elevation myocardial infarction (STEMI) prior to reperfusion therapy. Hyperglycemia is common on admission in patients with STEMI and is associated with a worse prognosis. Mechanisms remain unclear but may include impairment of coronary flow. The objective of this study was to examine whether acute hyperglycemia influenced the occurrence of SR in patients with STEMI. Methods: All patients presenting to our institution with acute STEMI with measurement of glucose levels on presentation were eligible. SR was defined as a combination of significant relief of chest pain associated with an at least 70% resolution of ST segment elevation on follow-up ECG. Results: 465 patients were studied of whom 77 patients met criteria for SR. Average glucose levels were not significantly different between the SR and non-SR groups (10.0±5.6 mmol/l versus 10.1±5.3; P=NS). When patients were divided into normoglycemic and hyperglycemic groups, there was no significant difference in the percentages of such patients in the SR and non-SR groups. (52% versus 54%; P=NS). Conclusions: Acute hyperglycemia on admission does not predict the occurrence of SR in a general population of patients with acute MI.