An overview of glycemic control in the coronary care unit with recommendations for clinical management.
The observation that elevated glucose occurs frequently in the setting of acute myocardial infarction was made decades ago. Since then numerous studies have documented that hyperglycemia is a powerful risk factor for increased mortality and in-hospital complications in patients with acute coronary syndromes. While some questions in this field have been answered in prior investigations, many critical gaps in knowledge continue to exist and remain subjects of intense debate. This review summarizes what is known about the relationship between hyperglycemia, glucose control, and outcomes in critically ill patients with acute coronary syndromes, addresses the gaps in knowledge and controversies, and offers general recommendations regarding glucose management in the coronary care unit.
Mid America Heart Institute of Saint Luke's Hospital, Kansas City, Missouri 64111, USA. mkosiborod@cc-pc.com
Mikhail
M
Kosiborod
Prakash
P
Deedwania
D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003325:Coronary Care Units; D016638:Critical Illness; D019317:Evidence-Based Medicine; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin