Hyperglycaemia in acute coronary syndromes: risk-marker or therapeutic target?

Abstract

Patients with acute coronary syndrome (ACS) often have raised blood glucose concentrations when admitted to hospital; a marker for poorer prognosis. Interventions to rapidly normalise blood glucose inconsistently are applied and with uncertain utility. Here we review the association of hyperglycaemia with outcome, present evidence that this hyperglycaemia reflects more than a pre-existing diabetic state and discuss mechanisms by which glucose may adversely affect the course of acute myocardial infarction (AMI). Finally, we seek evidence that intensive insulin treatment improves outcome.

Acute myocardial infarction in streptozotocin-induced hyperglycaemic rats: protection by a carbon monoxide-releasing molecule (CORM-3)

“…Many pharmacological tools have been employed in order to reduce the negative incidence hyperglycaemia may have on the prognosis of AMI both in humans and experimental models (Su et al 2007;Ishii et al 2006;Anantharaman and Heatley 2009;Marfella et al 2007a, b;Di Filippo et al 2004. However, due to the complexity of the pathology, it is very difficult to obtain exhaustive results.…”

Comparison of diagnostic criteria to detect undiagnosed diabetes in hyperglycaemic patients with acute coronary syndrome

“…This observation can partly be explained by the lack of convincing results of studies that have evaluated the clinical effectiveness of strategies aimed at early and strict plasma glucose regulation. It remains to be established whether hyperglycaemia is a marker or therapeutic target and which strategy would be best 7 8. Consequently, clinical treatment guidelines do not contain strong recommendations in this respect 9.…”

Usefulness of initial glucose level to improve acute coronary syndrome diagnosis in the emergency department

“…High glucose level on admission is also associated with short-term and long-term mortality and congestive heart failure in ACS 5 6…”