Significance of an index of insulin resistance in non-diabetic patients with impaired fasting glucose with acute myocardial infarction and its correlation to short term outcome.
OBJECTIVE
To investigate the potential role of a simple insulin resistance index i.e. Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) in identifying insulin resistance in patients admitted with an acute coronary syndrome without diabetes mellitus and its effect on short term outcome on cardiovascular morbidity and mortality.


METHODS
Seventy non-diabetic patients with impaired fasting glucose admitted with a diagnosis of acute myocardial infarction and followed prospectively for a median of six months for outcomes. Admission fasting glucose and insulin concentrations were measured and from these values an Insulin Resistance index was calculated.


RESULTS
During hospital course a high incidence of heart failure (11/;29 vs5/;41; p<0.05) and mortality (4/29 vs 1/41; p=0.152) was seen in patients with Index > 2 as compared to patients with Index <2, but mortality data failed to show any statistical significance because of small sample size. At six months patients with Index >2 had high incidence of heart failure (9/25 vs 4/40; p<0.020), reinfarct (2/25 vs. 0; p=0.141), repeated admissions (7/25 vs 3/40; p=0.092) and mortality (1/25 vs 1/40; p=0.181). Six out of twenty-five (p<0.001) patients with Index > 2 required antidiabetic treatment to achieve glycemic control.


CONCLUSIONS
A simple index of insulin resistance (Homeostatic Model Assessment-Insulin Resistance) measured on patients admitted with myocardial infarction provides an important predictive measure of poor outcome and is superior to admission glucose measurement. It may be useful in identifying patients admitted with myocardial infarction who could benefit from alternative early invasive strategies.
Sinha
Dhurjati P
DP
Department of Cardiology, Institute of Post Graduate Medical Education & Research, Kolkata, India.
Ahmed
Sagheer
S
Baneerjee
Amal Kr
AK
Das
Munna
M
Hassan
Haseeb
H
D001786:Blood Glucose; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index
D001786:Blood Glucose