title: A multicenter observational study on the management of hyperglycemia in patients with acute coronary syndrome.
abstract: OBJECTIVE
  To assess the prevalence, risk and management of hyperglycemia in patients with acute coronary syndrome (ACS).
  
  
  RESULTS
  
  
  
  METHODS
  a multicenter prospective observational study of a representative sample of patients with ACS consecutively admitted to intensive cardiac care units (ICCU).
  
  
  METHODS
  31 out of 61 ICCUs in Lombardy, the most heavily populated Italian region. From May 2009 to April 2010 1260 patients (69.4% male; mean age 68 ± 13 years) were included in the study: 301 (23.9%) were known diabetic patients (D) and 265 (21.0%) had hyperglycemia (H) (blood glucose >180 mg/dL) at hospital admission, 174 with a history of diabetes (D+H+) and 91 without (D-H+). On the first day after admission intravenous insulin infusion was prescribed to 72 D+H+ (41.4%) and 10 D-H+ (11.0%), according to different protocols. Approximately one third of D+H+ patients (59) and one fifth (17) of D-H+ maintained mean blood glucose higher than 180 mg/dL during the first day in the ICCU. Patients with diabetes or hyperglycemia had a higher incidence of major adverse cardiovascular events or death in hospital. However, at multivariable analysis neither diabetes nor blood glucose at admission was associated with a poor prognosis whereas mean blood glucose on the first day was an independent negative prognostic predictor (OR 1.010, 95% CI 1.002-1.018, p = 0.016).
  
  
  CONCLUSIONS
  Hyperglycemia is frequent in patients with ACS and is independently associated with a poor in-hospital prognosis if it persists in first day. Unfortunately, however, this condition is still poorly treated, with far from optimal blood glucose control.
authors: IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Desio Hospital, Desio, Italy. Electronic address: fausto.avanzini@marionegri.it.
authors: F
authors: F
authors: Avanzini
authors: San Carlo Borromeo Hospital, Milan, Italy.
authors: A
authors: A
authors: Mafrici
authors: IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors: E
authors: E
authors: Riva
authors: IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors: M G
authors: MG
authors: Franzosi
authors: IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors: V
authors: V
authors: Milani
authors: Bolognini Hospital, Seriate, Italy.
authors: V
authors: V
authors: Giudici
authors: Desio Hospital, Desio, Italy.
authors: G
authors: G
authors: Marelli
authors: San Carlo Borromeo Hospital, Milan, Italy.
authors: G
authors: G
authors: Mariani
authors: IRCCS-Ospedale San Raffaele, Milan, Italy.
authors: P M
authors: PM
authors: Piatti
authors: IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors: M C
authors: MC
authors: Roncaglioni
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003325:Coronary Care Units; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D007328:Insulin / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: Acute coronary syndrome; Diabetes mellitus; Hyperglycemia; Intensive cardiac care unit