Objective To determine the effect of insulin for the management of hyperglycaemia in non-diabetic patients presenting with acute coronary syndrome. .
Design Observational study from the MINAP (National Audit of Myocardial Infarction Project) database during 2003-5
Setting 201 hospitals in England and Wales
Patients Those with a final diagnosis of troponin-positive acute coronary syndrome who were not previously known to have diabetes mellitus and whose blood glucose on admission was iÝ 11 mmol/L .
Main outcome measures Death at 7 and 30 days
Results Of 38864 patients who were not previously known to be diabetic, 3835 (9.9%) had an admission glucose iÝ 11 mmol/L. Of patients having a clear treatment strategy 36% received diabetic treatment, (31% with insulin). Mortality at 7 days and 30 days was 11.6% and 15.8% for those receiving insulin and 16.5% and 22.1% for those who did not. Compared with those who received insulin, after adjustment for age, gender, co-morbidities and admission blood glucose concentration, patients who were not treated with insulin had a relative increased risk of death of 56% at 7 days and 51% at 30 days [Hazard ratio (HR)1.56, 95% Confidence Interval (CI) 1.22 to 2.0, p < 0.001 at 7 days, HR 1.51, 95% CI 1.22 to 1.86, p < 0.001 at 30 days].
Conclusion In non-diabetic patients with acute coronary syndrome and hyperglycaemia treatment with insulin was associated with a reduction in the relative risk of death, evident within 7 days of admission, which persists at 30 days.
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