A multicenter observational study on the management of hyperglycemia in patients with acute coronary syndrome

- We assessed the prevalence, risk and management of hyperglycemia in patients with acute coronary syndrome.
- One third of these patients had diabetes or hyperglycemia at hospital admission.
- Patients with persistent hyperglycemia in the first 24 h had the worst prognosis.
- Insulin i.v. infusion was under-used and nutritional treatment was often inadequate.
- In many hyperglycemic patients at admission blood glucose remained high throughout the next 24 h.

AimTo assess the prevalence, risk and management of hyperglycemia in patients with acute coronary syndrome (ACS).Methods and ResultsDesign: 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).ConclusionHyperglycemia 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.