title: Influence of bedside blood insulin measurement on acute coronary syndrome pathways.
abstract: BACKGROUND
  The aim of the study was to evaluate the influence of blood insulin measurements on acute coronary syndrome (ACS) pathways.
  
  
  METHODS
  All patients admitted to the emergency department within 12 months for acute, retrosternal, constrictive chest pain lasting for more than 30 minutes; cardiogenic pulmonary edema; electrocardiogram ST changes; and echographic alterations were included. The study parameters were clinical (age, sex, blood pressure, presence of pulmonary rales and gallop), including classic laboratory tests associated with troponin T, blood insulin levels, and hemoglobin A1C, and echographic values. These were taken on admission and throughout hospital stay. All patients underwent a coronary angiography for ACS diagnosis confirmation as well as treatment intention.
  
  
  RESULTS
  Sixty patients were included in the study. Abnormal blood insulin levels were present on admission in 47% of the population. Blood insulin level was significantly correlated to thrombolysis in myocardial infarction coronary perfusion score (Spearman Rank, 0.55, P < 0.0001). Abnormal insulinemia was normalized with reperfusion. Insulin was administered essentially to the 16 patients with hypoinsulinemia. Patients with hypoinsulinemia seem to have the most severe coronary lesions and highest Killip score.
  
  
  CONCLUSIONS
  In ACS, insulin levels are altered in half of the patients. After the investigators noted its tight correlation with the thrombolysis in myocardial infarction coronary flow score, its determination could be important in ACS for triggering emergency coronary angiography for percutaneous coronary intervention. This could modify the critical pathways of ACS patients in the emergency department.
authors.affiliation: Department of Critical Care, Brugmann University Hospital, Brussels, Belgium.
authors.forename: José
authors.initials: J
authors.lastname: Panza-Nduli
authors.forename: Very
authors.initials: V
authors.lastname: Coulic
authors.forename: Dominique
authors.initials: D
authors.lastname: Willems
authors.forename: Jacques
authors.initials: J
authors.lastname: Devriendt
authors.forename: Philippe
authors.initials: P
authors.lastname: Gottignies
authors.forename: Michel
authors.initials: M
authors.lastname: Staroukine
authors.forename: David
authors.initials: D
authors.lastname: De Bels
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015415:Biomarkers; D015897:Comorbidity; D003325:Coronary Care Units / Q000379:methods / Q000458:organization & administration; D019091:Critical Pathways; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems
chemical_list: D015415:Biomarkers; D007328:Insulin