COMUNICAZIONI - Giornale Italiano di Cardiologia

G Ital Cardiol Vol 8 Suppl 2-5 2007
demonstrated the advantage of early abciximab administration on pre-PCI
patency rate of the infarct related artery (IRA), resulting in improved myocardial
reperfusion and clinical outcome. It is not known whether early abciximab
administration influences myocardial reperfusion and functional recovery in the
subgroup of patients without pre-PCI optimal recanalization of the IRA (TIMI 3).
Methods. Out of the 210 consecutive pts enrolled, 174 (83%) showed pre-PCI
TIMI flow rate 4, pre-hospital delay> 2 hrs, pretreatment
delay >2 hrs, and age classes, were not significant. At 5-year follow-up,
mortality resulted significantly correlated with IRV flow before PCI (log rank
p=0.04).
survival
1,0
0,9
0,8
0,7
0,6
0,5
SURVIVAL ACCORDING TO IVR PATENCY BEFORE PCI
TIMI 3= 87%
TIMI 2= 82%
TIMI 0/1= 67%
0 20 40 60 80
follow up (months)
Conclusions. In a real world population, when organizational characteristics and
time delays significantly differ from RCT, a timely strategy of thrombolysis
followed by PCI (facilitated or rescue) warrants a better IVR patency compared to
the patients receiving a later pPCI, and this possibly explain the better 5-year
survival.
Infarto miocardico acuto: stratificazione prognostica
C92
ELEVATION OF GAMMA-GLUTAMYLTRANSFERASE LEVELS IN DIABETIC
PATIENTS SUFFERING FROM AN ACUTE MYOCARDIAL INFARCTION: AN
INDEX OF ADVERSE OUTCOME
S. Patanè*, F. Marte*, G. Di Bella**, R. Romeo*** , G. D’Andrea****, R. Giuffrè*,
A. Currò*, R. Parisi*
*Cardiologia, Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.D.G.
(ME), AUSL 5 Messina, **Cardiologia Policlinico Univ. Messina, ***Cardiologia,
Ospedale Giarre AUSL3, Catania, ****Diabetologia, Ospedale Milazzo AUSL 5,
Messina
Aim of the study. The pathophysiological dysfunction of protein kinases C
(PKCs) signaling pathways underlies the molecular basis of several
cardiovascular responses. In experimental models in obese diabetics animals
significant inhibition of insulin-induced glucose uptake, significant increase of
Reactive oxygen species (ROS),of basal glucose uptake and of activity of delta
PKC have been reported.The hypothesis that increased glucose intake increases
oxidative stress, which in turn promotes the activation of delta PKC and that
additional mechanisms may be operating to produce ROS under hyperglycemic
conditions, including the formation of advanced glycation end products or
activation of oxidases such as NADPH oxidase have been reported too. Gammaglutamyltransferase
(GGT) regulates PKC activity and its physiologic role is to
initiate the hydrolysis of extracellular glutathione (GSH). It has also been reported
GGT iron-dependent LDL oxidation and that the products of the GGT irondependent
reaction may themselves lead to increased free radical production.
There is some evidence from recent studies that GGT is independently
associated with cardiovascular mortality. Aim of this study was to investigate if
there were relations among higher GGT levels, ejection fraction and adverse
cardiac events in diabetic patients with Acute Myocardial Infarction (AMI) and
without renal failure.
Methods. We studied, in a retrospective analysis,140 diabetic patients with AMI
[94 patients with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) and
36 patients with ST-Segment Elevation Myocardial Infarction (STEMI)], divided in
two groups according to decrease of GGT (108 patients, named dGGT group) or
elevation of GGT (32 patients, named eGGT group) during hospitalization for
AMI. So we fixed a simple endpoint (Recurrent AMI, Heart Failure, Death) within
ten months from hospitalization and a composite endpoint with at least a single
adverse event.
Results. We found significant correlations as follows:
eGGT group (32pt) dGGT group (108pt) P value
Recurrent AMI 34,375% (11/32pt) 5,555556% (6/108pt)