Prognostic role of insulin resistance as assessed by homeostatic model assessment index in the acute phase of myocardial infarction in nondiabetic patients submitted to percutaneous coronary intervention

Lazzeri, Chiara; Sori, Andrea; Chiostri, Marco; Gensini, Gian Franco; Valente, Serafina

doi:10.1097/eja.0b013e32832a235c

Cited by 74 publications

(78 citation statements)

References 35 publications

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“…In our hospital, in Florence, the reperfusion strategy of STEMI patients is represented by primary PCI [14][15][16][17][18][19]. STEMI patients are first evaluated by the Medical Emergency System staff in the prehospital setting and then directly admitted to the catheterization laboratory or transferred to it after rapid stabilization in First Aid.…”

Section: Study Populationmentioning

confidence: 99%

“…On ICCU admission, after PCI, the following parameters were measured in a fasting blood sample: glucose (mg/dl), insulin values (mIU/l) [15,17], glycated hemoglobin (HbA1c, %), troponin I (ng/ml), C-reactive protein (mg/dl) (normal values \9), alanine aminotransferase (ALT, UI/l), aspartate amino transferase (AST, UI/l) [22], NT-pro brain natriuretic peptide (NT-pro BNP) (pg/ml) [18], total cholesterol (mg/dl), triglycerides (mg/dl), HDL (mg/dl), LDL (mg/dl), and fibrinogen (mg/dl). Creatinine (mg/dl) was also measured in order to calculate the glomerular filtration rate (eGFR, ml/min/1.73 m 2 , MDRD formula) [23].…”

Section: Study Populationmentioning

confidence: 99%

“…HOMA was calculated according to the following formula: {[fasting insulin (microU/ml)] 9 [fasting glucose (mmol/l)]}/22.5. Subjects whose values exceeded the sex-specific 75th percentile (i.e., 1.80 for women and 2.12 for men) were considered to have insulin resistance (HOMA-IR) [17,[25][26][27].…”

Section: Definition Of Insulin Resistancementioning

confidence: 99%

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Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes

et al. 2011

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Hypertension is well established as a risk factor for the development of atherosclerosis. Data on the impact of hypertension in patients with ST elevation myocardial infarction are so far inconsistent, and are mainly related to studies performed in the thrombolytic era. We assessed the impact of hypertension over the short and long term in 560 patients with ST elevation myocardial infarction (STEMI) and without previously known diabetes, all of whom were submitted to mechanical revascularization and consecutively admitted to our Intensive Cardiac Care Unit. Hypertensive patients were older (p \ 0.001), more frequently male (0.005), and they showed a reduced eGFR (p \ 0.001).Smoking was more frequent in nonhypertensive patients (p \ 0.001), while the incidence of three-vessel coronary artery disease was higher in hypertensive patients (p = 0.003). No difference in the in-hospital mortality rates for the two subgroups was detected. At follow-up (median 32.5 months, 25th-75th percentile 16.9-47.3 months), Kaplan-Meier survival analysis detected no differences in mortality between hypertensive and nonhypertensive patients (log rank v 2 0.38, p = 0.538). According to our data, obtained from a large series of consecutive STEMI patients without previously known diabetes, all of whom were submitted to primary PCI, a history of hypertension does not affect mortality over either the short or the long term. Moreover, hypertensive patients showed an altered glucose response to stress, as indicated by higher admission glucose values, poorer in-hospital glucose control, and a higher incidence of acute insulin resistance (as indicated by the HOMA index). Hypertensive patients therefore appear to warrant careful metabolic management during their hospital courses.

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Section: Study Populationmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

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Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes

et al. 2011

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“…HOMA was calculated according to the following formula: {[fasting insulin (microU/ml)] 9 [fasting glucose (mmol/l)]}/22.5 [27]. Subjects whose values exceeded the sex-specific 75th percentile (i.e., 1.80 for women and 2.12 for men) were considered to have insulin resistance (HOMA-IR) [14,28].…”

Section: Definition Of Insulin Resistancementioning

confidence: 99%

“…In non-diabetic STEMI patients undergone PCI, we reported that insulin resistance, as assessed by HOMA index, is quite common and helps in the early risk stratification, since it represents an independent predictor for in-hospital mortality [14]. Thus, the glycometabolic response to acute myocardial ischemia appears to be quite complex and, so far, poorly understood.…”

Section: Introductionmentioning

confidence: 99%

The glucose dysmetabolism in the acute phase of non-diabetic ST-elevation myocardial infarction: from insulin resistance to hyperglycemia

et al. 2011

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In the setting of acute myocardial infarction, hyperglycemia and acute insulin resistance may represent a stress response to myocardial injury mainly related to acute catecholamine release. By measuring glucose values and insulin resistance (Homeostatic Model Assessment index-HOMA), we evaluated in 356 non-diabetic patients with STelevation myocardial infarction (STEMI) undergone mechanical revascularization: (a) the acute glycometabolic response by evaluating insulin resistance, glucose levels, and their combination and (b) whether insulin resistance and increased glucose values (and their combination) are able to affect in-Intensive Cardiac Care Unit (ICCU) mortality and complications. In the overall population, 226 (63.5%) patients showed glucose values B140 mg/dl (group B), while 130 patients had glucose values[140 mg/dl (group A) (36.5%). Within group B, insulin resistance (as inferred by positive HOMA index) was present in 125 patients (55.3%), whereas 101 patients (44.7%) exhibited normal values of HOMA index. Within group A, 109 patients (83.8%) were insulin resistant, while 21 patients (16.2%) had normal values of HOMA index. At multivariable analysis, glucose values were independently associated with in-ICCU mortality (OR: 7.387; 95% CI 2.701-20.201; P \ 0.001) and complications (OR: 1.786; 95% CI 1.089-2.928; P = 0.022). In the early phase of STEMI, the acute glycometabolic response to stress is heterogeneous (ranging from no insulin resistance to glucose levels[140 mg/dl and, finally, to the combination of increased glucose values and insulin resistance). Increased glucose values are stronger prognostic factors since they are independently associated with in-ICCU mortality and complications.

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Hyperglycemia, acute insulin resistance, and renal dysfunction in the early phase of ST-elevation myocardial infarction without previously known diabetes: impact on long-term prognosis

et al. 2013

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We evaluated the relationship between admission renal function (as assessed by estimated glomerular filtration rate (eGFR)), hyperglycemia, and acute insulin resistance, indicated by the homeostatic model assessment (HOMA) index, and their impact on long-term prognosis in 825 consecutive patients with ST-elevation myocardial infarction (STEMI) without previously known diabetes who underwent primary percutaneous coronary intervention (PCI). Admission eGFR showed a significant indirect correlation with admission glycemia (Spearman's ρ -0.23, P < 0.001) and insulin values (Spearman's ρ -0.11, P = 0.002). The incidence of patients with admission glycemia ≥140 mg/dl was significantly higher in patients with eGFR <60 ml/min/m(2) (P < 0.001) as well as the incidence of HOMA positivity (P = 0.002). According to our data, a relationship between renal function and glucose values and acute insulin resistance in the early phase of STEMI was detectable, since a significant, indirect correlation between eGFR, insulin values, and glycemia was observed. Patients with renal dysfunction (eGFR <60 ml/min/1.73 m(2)) exhibited higher glucose values and a higher incidence of acute insulin resistance (as assessed by HOMA index) than those with normal renal function (eGFR ≥60 ml/min/1.73 m(2)). The prognostic role of glucose values for 1-year mortality was confined to patients with eGFR ≥60 ml/min/m(2), who represent the large part of our population and are thought to be at lower risk. In these patients, an independent relationship between 1-year mortality and glucose values was detectable not only for admission glycemia but also for glucose values measured at discharge.

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Prognostic role of insulin resistance as assessed by homeostatic model assessment index in the acute phase of myocardial infarction in nondiabetic patients submitted to percutaneous coronary intervention

Abstract: In nondiabetic STEMI patients submitted to percutaneous coronary intervention, insulin resistance, as assessed by HOMA index, is quite common and helps in the early prognostic stratification, as it represents an independent predictor of in-hospital mortality.

Cited by 74 publications

References 35 publications

Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes

Impact of hypertension on short- and long-term prognoses in patients with ST elevation myocardial infarction and without previously known diabetes

The glucose dysmetabolism in the acute phase of non-diabetic ST-elevation myocardial infarction: from insulin resistance to hyperglycemia

Hyperglycemia, acute insulin resistance, and renal dysfunction in the early phase of ST-elevation myocardial infarction without previously known diabetes: impact on long-term prognosis

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