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A multicenter observational study on the management of hyperglycemia in patients with acute coronary syndrome
F Avanzini1, A Mafrici2, E Riva3
1IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Desio Hospital, Desio, Italy.
Insights
Hyperglycemia is common in acute coronary syndrome (ACS) patients and predicts worse outcomes if it persists on the first day. Current management of hyperglycemia in ACS is suboptimal, indicating a need for improved treatment strategies.
Area of Science:
- Cardiology
- Endocrinology
- Critical Care Medicine
Background:
- Hyperglycemia is a frequent comorbidity in patients with acute coronary syndrome (ACS).
- The prognostic significance and optimal management of hyperglycemia in ACS remain areas of active investigation.
- Understanding the prevalence and impact of hyperglycemia is crucial for improving patient outcomes in ACS.
Purpose of the Study:
- To determine the prevalence of hyperglycemia in patients admitted with ACS.
- To evaluate the risk factors associated with hyperglycemia in this population.
- To assess the current management strategies and their effectiveness in controlling blood glucose levels.
Main Methods:
- A multicenter prospective observational study was conducted.
- 1260 patients with ACS admitted to intensive cardiac care units (ICCU) were consecutively enrolled.
- Data on diabetes history, blood glucose levels at admission and during the first day, and in-hospital outcomes were collected.
Main Results:
- 21.0% of patients presented with hyperglycemia (blood glucose >180 mg/dL) at admission.
- Patients with diabetes or hyperglycemia had a higher incidence of major adverse cardiovascular events or death.
- Persistent hyperglycemia on the first day in the ICCU, but not admission hyperglycemia or diabetes, was an independent predictor of poor in-hospital prognosis (OR 1.010, p=0.016).
Conclusions:
- Hyperglycemia is prevalent in ACS patients and is linked to adverse outcomes when it persists beyond the first day of intensive care.
- Current treatment protocols for hyperglycemia in ACS patients are inadequate, leading to suboptimal glycemic control.
- Further research and improved clinical guidelines are necessary to optimize hyperglycemia management in ACS.
Aim:
To assess the prevalence, risk and management of hyperglycemia in patients with acute coronary syndrome (ACS).
Design:
a multicenter prospective observational study of a representative sample of patients with ACS consecutively admitted to intensive cardiac care units (ICCU).
Setting:
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).
Conclusion:
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.
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