title: Admission Glycaemia and Acute Insulin Resistance in Heart Failure Complicating Acute Coronary Syndrome.
abstract: BACKGROUND
  Few data are so far available on the relation between increased glucose values and insulin resistance and mortality at short-term in patients with acute heart failure (AHF).
  
  
  METHODS
  The present investigation, performed in 409 consecutive patients with AHF complicating acute coronary syndrome (ACS), was aimed at assessing the prognostic role of admission glycaemia and acute insulin resistance (as indicated by the Homeostatic Model Assessment - HOMA index) for death during Intensive Cardiac Care (ICCU) stay. Admission glucose tertiles were considered.
  
  
  RESULTS
  In our series, diabetic patients accounted for the 33%. Patients in the third glucose tertiles exhibited the lowest LVEF (both on admission and at discharge), a higher use of mechanical ventilation, intra-aortic balloon pump and inotropic drugs and the highest in-ICCU mortality rate. In the overall population, hyperglycaemic patients (both diabetic and non diabetic) were 227 (227/409, 55.5%). Admission glycaemia was an independent predictor of in-ICCU mortality, together with admission LVEF and eGFR, while acute insulin resistance (as indicated by HOMA-index) was not associated with early death. The presence of admission hyperglycaemia in non-diabetic patients was independently associated with in-ICCU death while hyperglycaemia in diabetic patients was not.
  
  
  CONCLUSIONS
  According to our results, hyperglycaemia is a common finding in patients with ACS complicated by AHF and it is an independent predictor of early death. Non-diabetic patients with hyperglycaemia are the subgroup with the highest risk of early death.
authors.affiliation: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: lazzeric@libero.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.affiliation: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.affiliation: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.affiliation: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: D'Alfonso
authors.affiliation: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Spini
authors.affiliation: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Angelotti
authors.affiliation: Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, AOU Careggi, Fondazione Don Carlo Gnocchi IRCCS, Florence Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000150:complications / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D048909:Diabetes Complications / Q000097:blood / Q000628:therapy; D005260:Female; D038321:Glycemic Index; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000628:therapy; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000628:therapy; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose
keywords: Acute coronary syndrome; Acute heart failure; Acute insulin resistance; Hyperglycaemia; Prognosis