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Heart 1999;82:443-447; doi:10.1136/hrt.82.4.443
Copyright © 1999 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 1999;82:443-447 ( October )

Significance of an index of insulin resistance on admission in non-diabetic patients with acute coronary syndromes

P J Stubbsa, J Alaghband-Zadehc, J F Laycockd, P O Collinsone, G D Carterc, M I M Nobleb

a Department of Cardiology, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK, b National Heart and Lung Institute, Imperial College School of Medicine, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK, c Division of Diagnostic and Investigative Science, Imperial College School of Medicine, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK, d Division of Neurosciences, Imperial College School of Medicine, Charing Cross Campus, e Department of Chemical Pathology, Mayday University Hospital, Croydon, Surrey, UK

Correspondence to: Dr Stubbs.

Accepted for publication 5 May 1999

BACKGROUND---Insulin resistance is associated with ischaemic heart disease and has been proposed as a risk factor for subsequent myocardial infarction.
AIM---To investigate the potential use of a recently proposed insulin resistance index in identifying insulin resistance in patients admitted with an acute coronary syndrome.
METHODS---Single centre study of 441 non-diabetic patients admitted with chest pain to a coronary care unit and followed prospectively for a median of three years for outcome. Admission glucose and insulin concentrations were measured and from these values an admission index of insulin resistance (AIRI) calculated. Its association with other known factors in the insulin resistance syndrome, and subsequent outcome, was examined.
RESULTS---The AIRI was greater in patients with myocardial infarction than in a control group without myocardial infarction (p < 0.0001). A Cox regression model for subsequent cardiac death identified previous myocardial infarction (p < 0.0001), infarct size (p < 0.0001), and AIRI (p = 0.0033) as positive risk predictors. Patients of Indian subcontinent ethnic origin had greater AIRI values than white patients: mean (SD) 7.5 (1.3) v 4.6 (0.2), p < 0.001.
CONCLUSIONS---A simple index of insulin resistance measured on patients admitted with myocardial infarction provides an important predictive measure of poor outcome and is superior to admission glucose measurement. It may be useful in identifying patients admitted with myocardial infarction who could benefit from alternative early management strategies.


Keywords: myocardial infarction; unstable angina; insulin resistance; glucose

© 1999 by Heart
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