title: Early impact of insulin treatment on mortality for hyperglycaemic patients without known diabetes who present with an acute coronary syndrome.
abstract: 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.
authors.affiliation: Singleton Hospital, Swansea, UK.
authors.forename: C
authors.initials: C
authors.lastname: Weston
authors.forename: L
authors.initials: L
authors.lastname: Walker
authors.forename: J
authors.initials: J
authors.lastname: Birkhead
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents; D007328:Insulin