Article Text

other Versions

PDF
Early impact of insulin treatment on mortality for hyperglycaemic patients without known diabetes who present with an acute coronary syndrome.
  1. Clive Weston (cliveweston{at}doctors.org.uk)
  1. University of Wales, Swansea, United Kingdom
    1. Lynne Walker (lynne.walker{at}uclh.nhs.uk)
    1. The Heart Hospital, United Kingdom
      1. John Birkhead (john.birkhead{at}btinternet.com)
      1. The Heart Hospital, United Kingdom

        Abstract

        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.

        Statistics from Altmetric.com

        Request permissions

        If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.