الفهرس 
Coronary anatomyOnly 14 pages are availabe for public view
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Abstract
Acute Coronary Syndrome (ACS) is a leading cause of death worldwide. In addition to the other classic risk factors of CAD (smoking, male sex, hypercholesterolemia, and hypertension), diabetes is recognized as an important risk factor for coronary artery disease (CAD) and ACS. A body of information is now available suggests the need for a careful consideration not only of diabetes, but also of other disturbances of glucose metabolism, such as Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IFG), that have emerged as independent risk factors for cardiovascular disease mortality. Moreover, several prospective studies have shown a significant correlation between glycaemic variables and morbidity from coronary heart disease in patients with normal glucose tolerance. This study was conducted on 150 non-diabetic patients admitted with STEMI and treated with primary PCI at cardiovascular medicine department Tanta university hospitals within 6 months starting from June 2018. This study aimed to detect relationship between admission hyperglycemia and inhospital morbidity and mortality and angiographic result after primary PCI . We found that Hyperglycemia on admission in the absence of diabetes mellitus is a significant predictor of adverse outcome and the extent and severity of coronary artery lesions in non-diabetic patients presenting with STEMI high admission blood glucose associated with more LV systolic dysfunction . In addition recurrent anginal attacks, arrhythmias and cardiogenic shock were also more frequent among those patients. This may be related to the stress response that occurred early and lasted for several days, with subsequent release of more catecholamine and corticosteroids during which increased gluconeogenesis and lipolysis lead to increased circulating glucose, free-fatty acids and lactic acid . These metabolic disturbances change metabolic substrate for myocardium which became intoxicated . Also hyperglycemia in patients hospitalized with an AMI. Hyperglycemia can cause QT-interval prolongation , which can trigger ventricular arrhythmias in those with underlying coronary artery disease . Hyperglycemia is also associated with increase risk for developing contrast induced nephropathy by inducing osmotic diuresis, resulting in volume depletion and increasing the risk for pre renal azotemia and contrast toxicity .and increasing production of oxygen free radicals with increased oxidative stress and suppressed flow mediated vasodilatation, inducing medullary hypoxia and ischemia, thus exacerbating the deleterious effect of contrast Also macrovascular and microvascular dysfunction seen in hyperglycemia is possibly mediated by nitric oxide-mediated endothelial and platelet effect and may account in part for the lower rate of spontaneous reperfusion and higher rate of “no-reflow” seen with elevated blood glucose levels in acute myocardial infarctions. In Our study we found that Patients with elevated blood glucose level had high level of CKMB due to more necrosis of myocardium. Also had high risk for developing TIMI 0 or “no-reflow” and periprocedural death - cardiogenic shock – ventricular arrhythmia- acute heart failure–re infarction – contrast induced nephropathy.