Early impact of insulin treatment on mortality for hyperglycaemic patients without known diabetes who present with an acute coronary syndrome.
OBJECTIVE
To determine the effect of insulin for the management of hyperglycaemia in non-diabetic patients presenting with acute coronary syndrome.


METHODS
An observational study from the MINAP (National Audit of Myocardial Infarction Project) database during 2003-5 in 201 hospitals in England and Wales. Patients were those with a final diagnosis of troponin-positive acute coronary syndrome who were not previously known to have diabetes mellitus and whose blood glucose on admission was > or = 11 mmol/l. The main outcome measure was death at 7 and 30 days.


RESULTS
Of 38,864 patients who were not previously known to be diabetic, 3835 (9.9%) had an admission glucose > or = 11 mmol/l. Of patients having a clear treatment strategy, 36% received diabetic treatment (31% with insulin). Mortality at 7 and 30 days was 11.6% and 15.8%, respectively, for those receiving insulin, and 16.5% and 22.1%, respectively, for those who did not. Compared with those who received insulin, after adjustment for age, gender, co-morbidities and admission blood glucose concentration, patients who were not treated with insulin had a relative increased risk of death of 56% at 7 days and 51% at 30 days (HR 1.56, 95% CI 1.22 to 2.0, p<0.001 at 7 days; HR 1.51, 95% CI 1.22 to 1.86, p<0.001 at 30 days).


CONCLUSIONS
In non-diabetic patients with acute coronary syndrome and hyperglycaemia, treatment with insulin was associated with a reduction in the relative risk of death, evident within 7 days of admission, which persists at 30 days.
Weston
C
C
Singleton Hospital, Swansea, UK.
Walker
L
L
Birkhead
J
J
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D002317:Cardiovascular Agents / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000401:mortality; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D016896:Treatment Outcome
D001786:Blood Glucose; D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents; D007328:Insulin