Admission Glycaemia and Acute Insulin Resistance in Heart Failure Complicating Acute Coronary Syndrome

Chiara Lazzeri, Serafina Valente, Marco Chiostri, Maria Grazia D'Alfonso, Valentina Spini, Paola Angelotti, Gian Franco Gensini

Research output: Contribution to journalArticle

Abstract

Background: Few data are so far available on the relation between increased glucose values and insulin resistance and mortality at short-term in patients with acute heart failure (AHF). Methods: The present investigation, performed in 409 consecutive patients with AHF complicating acute coronary syndrome (ACS), was aimed at assessing the prognostic role of admission glycaemia and acute insulin resistance (as indicated by the Homeostatic Model Assessment - HOMA index) for death during Intensive Cardiac Care (ICCU) stay. Admission glucose tertiles were considered. Results: In our series, diabetic patients accounted for the 33%. Patients in the third glucose tertiles exhibited the lowest LVEF (both on admission and at discharge), a higher use of mechanical ventilation, intra-aortic balloon pump and inotropic drugs and the highest in-ICCU mortality rate.In the overall population, hyperglycaemic patients (both diabetic and non diabetic) were 227 (227/409, 55.5%). Admission glycaemia was an independent predictor of in-ICCU mortality, together with admission LVEF and eGFR, while acute insulin resistance (as indicated by HOMA-index) was not associated with early death. The presence of admission hyperglycaemia in non-diabetic patients was independently associated with in-ICCU death while hyperglycaemia in diabetic patients was not. Conclusions: According to our results, hyperglycaemia is a common finding in patients with ACS complicated by AHF and it is an independent predictor of early death. Non-diabetic patients with hyperglycaemia are the subgroup with the highest risk of early death.

Original languageEnglish
Pages (from-to)1074-1080
Number of pages7
JournalHeart Lung and Circulation
Volume24
Issue number11
DOIs
Publication statusPublished - Nov 1 2015

Keywords

  • Acute coronary syndrome
  • Acute heart failure
  • Acute insulin resistance
  • Hyperglycaemia
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine

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    Lazzeri, C., Valente, S., Chiostri, M., D'Alfonso, M. G., Spini, V., Angelotti, P., & Gensini, G. F. (2015). Admission Glycaemia and Acute Insulin Resistance in Heart Failure Complicating Acute Coronary Syndrome. Heart Lung and Circulation, 24(11), 1074-1080. https://doi.org/10.1016/j.hlc.2015.04.171