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

F. Avanzini, A. Mafrici, E. Riva, M. G. Franzosi, V. Milani, V. Giudici, G. Marelli, G. Mariani, P. M. Piatti, M. C. Roncaglioni, Claudio Cuccia, Chiara Forgione, Giovanna Baronio, Claudio Bonifazi, Simonetta Vinci, Francesco Gentile, Davide Esposti, Dario Cirino, Laura Monti, Maurizio BalsamoCarlo Bianchi, Donatella Covini, Mauro Santarone, Giovanni Foglia Manzillo, Silvia Chiaravalloti, Sonia Molteni, Santo Claudio Zerboni, Simona Colombo, Vigilio Ziacchi, Andrea Ferrazza, Mario De Martini, Donata Saltafossi, Walter Bonini, Davide Agnelli, Alessandra Moscatelli, Silvano Perotti, Claudia Conti, Roberto Canziani, Daniela Orsida, Monica Morale, Gigliola Lo Russo, Alessandro Politi, Roberta Gestra, Brunella Della Bitta, Mario Orlandi, Egidio Marangoni, Miriam Villani, Arianna Ferrari, Roberto Zanini, Antonio Izzo, Raffaella Motti, Emanuela Trazzi, Stefano Maggiolini, Roberto Galbiati, Giancarlo Marenzi, Monica De Metro, A. Todisco, Maurizio Viecca, Roberto Sala, Armando Belloni, Claudio Apruzzese, Ernesto Evicelli, Gian Battista Danzi, Antonella Fedele, Silvio Klugmann, Luigia Muggeo, Alberto Margonato, Domenico Cianflone, Giuseppe Pizzetti, Giorgio Bassanelli, Roberta Zini, Antonio Grieco, Alessandro Bozzano, Marta Alloni, Guido Vitali, Maria Cristina Brunazzi, Maurizio Negrelli, Maddalena Colicci, Chiara Marcomin, Flavio Doni, Margherita Manfredi, Francesco Pattarino, Patrizia Presbitero, Elena Corrada, Ornela Llazo, Daniele Nassiacos, Pierluigi Pittana, Maurizio Tespili, Alessandra Costalunga, Edoardo Gronda, Bruno Andreuzzi, Beatrice Riva, Andrea Antonelli, Gaia Magnaghi, Mario Mazza, Gianfranco Cucchi, Enrica Giavatti, Eugenio Cazzani, Paola Grimoldi, Alberto Limido, Stefano Giani, Xhepa Eriom, Paolo Marchesi, Gianpietro Marinoni, Riccardo Osti, Luisella Saviotti, Giulio Mariani, Maria Grazia Franzosi, Vittorio Giudici, Giuseppe Marelli, Pier Marco Piatti, Emma Riva, Maria Carla Roncaglioni, Simona Barlera, Valentina Milani, Elena Raimondi, Alessandra Carnaghi, Enrico Nicolis, Daniele Piovani, Cristina Tognaccini

Research output: Contribution to journalArticle

Abstract

Aim: To assess the prevalence, risk and management of hyperglycemia in patients with acute coronary syndrome (ACS). Methods and Results: Design: 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). Conclusion: Hyperglycemia 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.

Original languageEnglish
Pages (from-to)916-923
Number of pages8
JournalNutrition, Metabolism and Cardiovascular Diseases
Volume25
Issue number10
DOIs
Publication statusPublished - Oct 1 2015

Keywords

  • Acute coronary syndrome
  • Diabetes mellitus
  • Hyperglycemia
  • Intensive cardiac care unit

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine

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    Avanzini, F., Mafrici, A., Riva, E., Franzosi, M. G., Milani, V., Giudici, V., Marelli, G., Mariani, G., Piatti, P. M., Roncaglioni, M. C., Cuccia, C., Forgione, C., Baronio, G., Bonifazi, C., Vinci, S., Gentile, F., Esposti, D., Cirino, D., Monti, L., ... Tognaccini, C. (2015). A multicenter observational study on the management of hyperglycemia in patients with acute coronary syndrome. Nutrition, Metabolism and Cardiovascular Diseases, 25(10), 916-923. https://doi.org/10.1016/j.numecd.2015.07.007