Glycemic variability and cardiac remodeling in patients with acute myocardial infarction.

ous glucose monitoring system (CGMS) on left ventricular (LV) remodeling in 69 patients with a first reperfused STsegment elevation MI within 12 h of onset. LV remodeling was assessed by cardiac magnetic resonance imaging (CMR). Patients were equipped with a CGMS when in a stable phase after admission and underwent repeat CMR at baseline and 7 months follow-up. One of the important points in this study is that the authors excluded those with medications for DM to eliminate the effect of such medications on GV. The baseline HbA1c level was not so high and was equivalent between the high mean amplitude of glycemic excursion (MAGE) group (Group H) and low MAGE group (Group L) (5.9±0.6 vs. 5.8±0.4, P=0.3). Glucose level on admission was also not significantly different between the 2 groups. Regarding the myocardial damage in the acute phase, there was no significant difference between groups H and L with regard to the mean extent of core (19±9% LV mass vs. 20±1% LV mass, P=0.518) and peak creatine phosphokinase levels. At 7-month follow-up, the HbA1c levels were also not significantly different between the 2 groups (6.0±0.5 vs. bnormal glucose metabolism is an important prognostic factor in patients with acute myocardial infarction (AMI). Blood glucose levels are commonly elevated,1 and raised blood glucose concentrations on admission are reported to be associated with increased mortality in patients with AMI.2 Elevated fasting glucose is also reported to be associated with 30-day mortality in AMI patients.3 Furthermore, hypoglycemia on admission is associated with higher in-hospital and long term mortality compared with euglycemia.4 Acute glycemic fluctuations from peaks to nadirs, socalled glycemic variability (GV), has been also reported as associated with higher risk for mortality in patients with diabetes mellitus (DM).5 However, there are insufficient data regarding the association of GV and clinical outcomes in AMI patients.