title: The glucose dysmetabolism in the acute phase of non-diabetic ST-elevation myocardial infarction: from insulin resistance to hyperglycemia.
abstract: In the setting of acute myocardial infarction, hyperglycemia and acute insulin resistance may represent a stress response to myocardial injury mainly related to acute catecholamine release. By measuring glucose values and insulin resistance (Homeostatic Model Assessment index-HOMA), we evaluated in 356 non-diabetic patients with ST-elevation myocardial infarction (STEMI) undergone mechanical revascularization: (a) the acute glycometabolic response by evaluating insulin resistance, glucose levels, and their combination and (b) whether insulin resistance and increased glucose values (and their combination) are able to affect in-Intensive Cardiac Care Unit (ICCU) mortality and complications. In the overall population, 226 (63.5%) patients showed glucose values ≤140 mg/dl (group B), while 130 patients had glucose values >140 mg/dl (group A) (36.5%). Within group B, insulin resistance (as inferred by positive HOMA index) was present in 125 patients (55.3%), whereas 101 patients (44.7%) exhibited normal values of HOMA index. Within group A, 109 patients (83.8%) were insulin resistant, while 21 patients (16.2%) had normal values of HOMA index. At multivariable analysis, glucose values were independently associated with in-ICCU mortality (OR: 7.387; 95% CI 2.701-20.201; P < 0.001) and complications (OR: 1.786; 95% CI 1.089-2.928; P = 0.022). In the early phase of STEMI, the acute glycometabolic response to stress is heterogeneous (ranging from no insulin resistance to glucose levels >140 mg/dl and, finally, to the combination of increased glucose values and insulin resistance). Increased glucose values are stronger prognostic factors since they are independently associated with in-ICCU mortality and complications.
authors: Intensive Cardiac Coronary Unit, Department of Heart and Vessel, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy. lazzeric@libero.it
authors: Chiara
authors: C
authors: Lazzeri
authors: Serafina
authors: S
authors: Valente
authors: Marco
authors: M
authors: Chiostri
authors: Paola
authors: P
authors: Attanà
authors: Claudio
authors: C
authors: Picariello
authors: Gian Franco
authors: GF
authors: Gensini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D002395:Catecholamines / Q000378:metabolism; D015897:Comorbidity; D017023:Coronary Angiography; D003422:Critical Care; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000378:metabolism* / Q000401:mortality; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000502:physiology*
chemical_list: D001786:Blood Glucose; D002395:Catecholamines