Date of Graduation

Summer 8-10-2013

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Mark Pedemonte, MD

Abstract

Background: Type II diabetes mellitus (DM II) and coronary artery disease (CAD) are widely understood to be intimately intertwined disease processes. Today, coronary artery disease is the leading cause of morbidity and mortality worldwide, and the prevalence of diabetes is reaching epidemic proportions. New therapies for the management type II DM utilizing incretin mimetics including Glucagon like peptide (GLP-1) receptor agonists are revolutionizing the current management of DM II. The purpose of this study was to attempt to elucidate whether GLP-1 infusions improve cardiac markers in setting of acute myocardial infarction (AMI) in humans.

Methods: An exhaustive search of Medline-OVID, CINAHL, EBMR Multifile, and Web of Science using the keywords: GLP-1, exenatide, liraglutide, myocardial infarction, myocardial ischemia, cardioprotection, angioplasty, percutaneous coronary intervention (PCI), ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI). All bibliographies were screened for relevant articles. All relevant articles were assessed for quality using GRADE.

Results: Three studies met inclusion criteria and included in this systematic review. A randomized, double-blinded, placebo-controlled trial of 172 ST-elevation myocardial infarction (STEMI) patients revealed a 15% larger myocardial salvage index and a 23% smaller final infarct size in the treatment group. A post-hoc analysis of this data investigating system delay demonstrated no difference between groups with delay >132 minutes. The final study was a non-randomized pilot study of 21 AMI patients demonstrated improved left ventricular ejection fraction (LVEF) in the GLP-1–treated group.

Conclusion: Longer duration GLP-1 infusions have been shown to improve LVEF in AMI, a finding that is more pronounced in patients with clinically severe disease or patients under cardiovascular stress. GLP-1 infusions also increase myocardial salvage and decrease final infarct size. The data is suggestive that GLP-1 infusions have a more profound effect on larger infarcts. There is an upper limit to the timing of GLP-1 administration,which appears to beFinally, GLP-1 infusions also appear to decrease morbidity and mortality themselves, as evidenced by the reduction of in-hospital mortality and length of hospital stay in AMI patients undergoing PCI.

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