Coronary Artery Disease (PG Steg, Section Editor)

Current Treatment Options in Cardiovascular Medicine

, Volume 15, Issue 1, pp 93-103

First online:

How to Manage Hyperglycemia in an Acute Coronary Syndrome Patient

  • David VivasAffiliated withInstituto Cardiovascular, Hospital Universitario San Carlos
  • , Esther BernardoAffiliated withInstituto Cardiovascular, Hospital Universitario San Carlos
  • , Julian Palacios-RubioAffiliated withInstituto Cardiovascular, Hospital Universitario San Carlos
  • , Antonio Fernández-OrtizAffiliated withInstituto Cardiovascular, Hospital Universitario San Carlos Email author 

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Opinion statement

Evidences on hyperglycemia management in patients with acute coronary syndrome (ACS) are scarce and controversial. While approaches such as infusion of glucose, insulin, and potassium (GIK therapy) have not demonstrated any improvement in outcome, glycemic control by means of either continuous insulin infusion or subcutaneous on-demand boluses may be useful only when glycaemia is successfully controlled. Nevertheless, results from several studies are controversial and there is no consensus on glycaemia target values. Concerning oral antidiabetic treatment, previous reports stated an increase in heart attacks throughout their chronic use, however no studies have addressed the effects of either starting or continuing oral antidiabetics during ACS setting. Therefore, there is not enough evidence to strongly recommend any specific therapy to manage hyperglycemia in an ACS patient other than trying to keep glycaemia within reasonable levels (usually defined by consensus), and there is evidence discouraging the use of GIK therapy since no beneficial effect has been observed.


Hyperglycemia Acute coronary syndrome Diabetes mellitus Platelets Insulin Oral antidiabetic drugs Acute myocardial infarction Thrombosis