title: Acute insulin resistance assessed by the homeostatic model assessment in acute coronary syndromes without previously known diabetes.
abstract: We assessed the incidence and the prognostic role for early death of acute insulin resistance (by means of homeostatic model assessment [HOMA] index) in 1350 patients with acute coronary syndrome (ACS) consecutively admitted to our intensive cardiac care unit (ICCU). The incidence of HOMA positivity was 5% (68 of 1350), with the highest percentage of HOMA positivity among ST-segment elevation myocardial infarction (STEMI). Patients with HOMA positivity showed a higher body mass index (P = .003), lower values of admission and discharge left-ventricular ejection fraction (LVEF; P < .001 and P = .003, respectively), and higher levels of peak troponin I (Tn I; P < .001). The HOMA index was an independent predictor of early death (odds ratio 1.724, 95% confidence interval 1.252-2.375, P = .001). In patients with ACS and without previously known diabetes, acute insulin resistance (HOMA index) is associated with a larger myocardial damage (ie, higher values of peak Tn I and lower LVEF) and a greater inflammatory activation (indicated by correlation with leukocyte count). The HOMA positivity was an independent predictor of in-ICCU mortality.
authors: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy lazzeric@libero.it.
authors: Chiara
authors: C
authors: Lazzeri
authors: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Serafina
authors: S
authors: Valente
authors: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Marco
authors: M
authors: Chiostri
authors: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Paola
authors: P
authors: Attanà
authors: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Alessio
authors: A
authors: Mattesini
authors: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Gian Franco
authors: GF
authors: Gensini
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006706:Homeostasis; D017052:Hospital Mortality; D006801:Humans; D007333:Insulin Resistance; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013318:Stroke Volume; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I
keywords: acute coronary syndrome; acute insulin resistance; early death; without previously known diabetes