| Objective: The purpose of this study was to investigate the effects of different serum insulin level on coronary myocardial microcirculation perfusion, left ventricular function and prognosis for post-PCI patients with acute myocardial infarction (AMI), according to comparison of the clinical characters: serum C-reactive protein (CRP), homocysteine (HCY), B-Type Natriuretic Peptide (BNP), and coronary artery lesion, the left ventricular function, and the occurrence of cardiac events . Methods: This study was performed in sixty-two patients(46 male and 16 female, average age was 57.37±11.52 years old) with first AMI admitted to our hospital from July 2003 to December 2004. All patients were the first onset of AMI and were diagnosed corresponding the criterion of ACC/AHA: ⑴all patients had persistent angina for more than thirty minutes;⑵The cardiac enzyme (CK, CK-MB) peak increased beyond more than two folds of normal range and troponin T was positive. ⑶The electrocardiographic evidence of ST-segment elevation evolved in two or more bordering leads or newly appeared left brindle branch block. Defining the exclusion criteria: ⑴the history of old myocardial infarction;⑵the history of coronary artery bridge graft (CABG) ; ⑶serious chronic heart failure, left main trunk lesion, cardiac shock; ⑷serious valvular heart disease; ⑸dilated and hypertrophic cardiomyopathy; ⑹serious renal failure; ⑺acute or chronic infection, chronic obstructive pulmonary disease (COPD), bronchial asthma; ⑻serious endocrine disease or 1-type diabetes mellitus, 2-type diabetes mellitus companied with serious complications; ⑼sensitive to or contra-indication of anti-coaglulation drugs ; refused CAG or PCI. All patients were extracted blood from peripheral venous to test blood routin, liver and renal function, fasting blood sugar, fasting blood insulin(Ins), HbA1c, CRP, HCY, BNP. We divided all patients to two groups according to serum insulin: group A (Ins<15 mU/L n=32) and group B (hyperinsulinemia) (Ins≥15 mU/L n=25) .We collected detailed clinical information including risk factors in two groups. All patients were accepted emergency CAG, and the results of CAG were analyzed by two intervention cardiologists who were unware of this study ,using the quantitative coronary anaylsis(QCA) to evaluate the condition of coronary artery and identifying the infarct related artery(IRA), coronary artery stenosis ≥70% was considered significant. After evaluating the collateral circulation according to Rentrop grade criteria, recanalized IRA through PCI. After PCI we estimated the myocardial microcirculation perfusion according to the myocardial blush grade (MBG), recording the left ventricular end diastolic pressure (LVEDP) through left ventriculography (LVG). Myocardiac enzymes werecontinuously measured before and after PCI. All patients performed echocardiography (UCG) to measure the left ventricular ejection fraction (LVEF) and cardiac index (CI). All patients'laboratory data and cardiac function index were recorded. The occurrence of major adverse cardiac events (MACE) in hospital was also obtained. SPSS11.5 statistic software was used to analysis all the data. The numerical variable was presented as mean±SD, the categorical variable was presented as rate or percentage. Spearman correlation was used to evaluate the correlations between Ins and CRP,HCY,BNP. Statistical significance was indicated by P value<0.05. Results:⑴There was no significant difference of the baseline characteristics between the two groups, including the age, sex, hypertension, hypercholesteral, diabetes, history of smoking, drinking, location of infarction and time to reperfusion of IRA. The incidence of pre-angina in group A were more than in group B (65.0% vs. 29.0%,P<0.01). The occurrence of TIMI 3 grade in group B were higher than in group A (64.0% vs. 35.1%, P<0.05). ⑵CAG showed: The percent of single vessel lesion and two vessel lesion and multivessel lesion were similar between two groups, no statistical difference (48.6% vs. 52.0%; 27.0% vs. 20.0% ; 24.3...
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