PT  - JOURNAL ARTICLE
AU  - C Weston
AU  - L Walker
AU  - J Birkhead
TI  - Early impact of insulin treatment on mortality for hyperglycaemic patients without known diabetes who present with an acute coronary syndrome
AID  - 10.1136/hrt.2006.108696
DP  - 2007 Dec 01
TA  - Heart
PG  - 1542--1546
VI  - 93
IP  - 12
4099  - http://heart.bmj.com/content/93/12/1542.short
4100  - http://heart.bmj.com/content/93/12/1542.full
SO  - Heart2007 Dec 01; 93
AB  - Objective: To determine the effect of insulin for the management of hyperglycaemia in non-diabetic patients presenting with acute coronary syndrome.Methods: An observational study from the MINAP (National Audit of Myocardial Infarction Project) database during 2003–5 in 201 hospitals in England and Wales. Patients were 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 ⩾11 mmol/l. The main outcome measure was death at 7 and 30 days.Results: Of 38 864 patients who were not previously known to be diabetic, 3835 (9.9%) had an admission glucose ⩾11 mmol/l. Of patients having a clear treatment strategy, 36% received diabetic treatment (31% with insulin). Mortality at 7 and 30 days was 11.6% and 15.8%, respectively, for those receiving insulin, and 16.5% and 22.1%, respectively, 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 (HR 1.56, 95% 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.