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Insulin Reduces Mortality in Patients With ACS and Hyperglycemia

Posted: Thursday, December 13, 2007

Insulin treatment of nondiabetic patients with acute coronary syndrome (ACS) and hyperglycemia is associated with reduced risk of death in the first 30 days.

Dr. John S. Birkhead from The Heart Hospital, London, UK states that, "Glucose per se is toxic at 198mg/dL (11 mmol/L) at admission and this should be treated with insulin."

Dr. Birkhead and colleagues used data from the National Audit of Myocardial Infarction Project (MINAP) to examine the association of treatment with insulin with outcome in patients who were not previously known to be diabetic and who presented to hospital with ACS and an admission blood glucose of at least 198mg/dL(11 mmol/L.)

The death rate at 7 days was 11.6% in patients receiving insulin and 16.5% in those not receiving insulin, the investigators report, and the 30-day death rates were 15.8% and 22.1%, respectively.

Compared with patients treated with insulin, those who were not treated had a 56% higher risk of death at 7 days and a 51% higher risk of death at 30 days after adjustment for age, gender, pre-existing heart or renal failure, admission blood glucose, presence of ST elevation infarction, and history of previous angina or myocardial infarction.

Moreover, the relative increased risk of death for patients not treated with insulin was even higher after adjustment for the use of any reperfusion treatment.

"These observational data show for the first time that nondiabetic patients presenting with hyperglycemia in association with an acute coronary syndrome have a better short-term prognosis when they are treated with insulin," the researchers conclude.

"We do not suggest that a level of 198mg/dL (11 mmol/L) is the optimum point for introduction of treatment, as others have shown a steadily increasing mortality in relation to increasing glucose levels throughout the range of blood sugars encountered," the authors note. "This suggests that a lower threshold for treatment may ultimately be considered appropriate."

"Glucose/insulin/potassium is dead, but sadly will not lie down," Dr. Birkhead added. "Control of glucose seems important, and putting more into the patient is a bad idea."

Source: Diabetes In Control: Heart 2007;93:1542-1546.