Hospital outcome in patients with ST segment elevation myocardial infarction in relation to hyperglycaemia and tumour necrosis factor alpha / Taha Ahmed Ali Saleh Almaimoony ; Supervised Zeinab Attia Ashour , Hossam Eldein Ghanem Elhossary , Yasser Yazeed Abdelmoneam

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Cardiology

Aims: To test whether hyperglycemia and inflammation detected in patients with acute ST- elevation myocardial infarction (STEMI) is a predictor of in-hospital major adverse cardiovascular events (MACE). Methods: 81 patients with an acute STEMI were enrolled in this clinical study. The studied patients were classified into 3 groups, group A included patients with a plasma glucose (< 200 mg/dl) and no previous history of diabetes, group B included diabetic patients with hyperglycemia and group C included patients with hyperglycemia and no history of diabetes. Tumor necrosis factor alpha (TNF-Ü), white blood count (WBC), and their subtypes were analyzed during hospitalization The primary end point was the composite of mortality, arrhythmia, recurrent nonfatal MI, or heart failure (MACEs) during the hospital stay. Results: Compared with the other groups, group C patients had significantly higher plasma levels of cardiac biomarker (Troponin I and CK-MB) and inflammatory marker (TNF and WBCs, p < 0.01) while MACEs developed more among groups B and C groups. Seventeen (21.8%) patients suffered MACE (mortality in 6 patients, heart failure in 13, re-infarction in 3, atrial fibrillation in 3 and one patient developed heart block. TNF Ü level, Troponin I and the left ventricular ejection fraction were the most independent predictor of the MACEs after acute STEMI. An admission cutoff value of blood glucose level > 230mg/dl cut-off showed sensitivity of 76.5% and specificity of 63.9% as predictor of MACEs

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