Abstract
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 ST-elevation 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 ≤140 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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References
Opie LH (2008) Metabolic management of acute myocardial infarction comes to the fore and extends beyond control of hyperglycemia. Circulation 117(17):2172–2177
Oswald GA, Smith CC, Betteridge DJ et al (1986) Determinants and importance of stress hyperglycaemia in non-diabetic patients with myocardial infarction. Br Med J (Clin Res Ed) 293(6552):917–922
Lazzeri C, Tarquini R, Giunta F, Gensini GF (2009) Glucose dysmetabolism and prognosis in critical illness. Intern Emerg Med 4(2):147–156
Deedwania P, Kosiborod M, Barrett E et al. (2008) American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity and Metabolism. Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 117(12):1610–1619
Kosiborod M, Rathore SS, Inzucchi SE (2005) Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 111(23):3078–3086
Kosiborod M, Inzucchi SE, Krumholz HM et al (2008) Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation 117(8):1018–1027
Kosiborod M, Inzucchi SE, Krumholz HM et al (2009) Glucose normalization and outcomes in patients with acute myocardial infarction. Arch Intern Med 169(5):438–446
Svensson AM, McGuire DK, Abrahamsson P, Dellborg M (2005) Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J 26(13):1255–1261
Goyal A, Mahaffey KW, Garg J et al (2006) Prognostic significance of the change in glucose level in the first 24 h after acute myocardial infarction: results from the CARDINAL study. Eur Heart J 27(11):1289–1297
Suleiman M, Hammerman H, Boulos M et al (2005) Fasting glucose is an important independent risk factor for 30-day mortality in patients with acute myocardial infarction: a prospective study. Circulation 111(6):754–760
Lazzeri C, Chiostri M, Sori A, Valente S, Gensini GF (2010) Postprocedural hyperglycemia in ST elevation myocardial infarction submitted to percutaneous coronary intervention: a prognostic indicator and a marker of metabolic derangement. J Cardiovasc Med 11(1):7–13
Nishio K, Shigemitsu M, Kusuyama T, Fukui T, Kawamura K, Itoh S, Konno N, Katagiri T (2006) Insulin resistance in nondiabetic patients with acute myocardial infarction. Cardiovasc Revasc Med 7(2):54–60
Wallander M, Bartnik M, Efendic S (2005) Beta cell dysfunction in patients with acute myocardial infarction but without previously known type 2 diabetes: a report from the GAMI study. Diabetologia 48(11):2229–2235
Lazzeri C, Sori A, Chiostri M, Gensini GF, Valente S (2009) 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. Eur J Anaesthesiol 26(10):856–862
Saberi F, Heyland D, Lam M, Rapson D, Jeejeebhoy K (2008) Prevalence, incidence, and clinical resolution of insulin resistance in critically ill patients: an observational study. JPEN 32(3):227–235
Valente S, Lazzeri C, Chiostri M, Chiostri M, Giglioli C, Sori A, Tigli S, Gensini GF (2009) NT-proBNP on admission for early risk stratification in STEMI patients submitted to PCI. Relation with extension of STEMI and inflammatory markers. Int J Cardiol 132(1):84–89
Valente S, Lazzeri C, Saletti E, Chiostri M, Gensini GF (2008) Primary percutaneous coronary intervention in comatose survivors of cardiac arrest with ST-elevation acute myocardial infarction: a single-center experience in Florence. J Cardiovasc Med 9(11):1083–1087
Buiatti E, Barchielli A, Marchionni N et al (2003) Determinants of treatment strategies and survival in acute myocardial infarction: a population-based study in the Florence district, Italy: results of the acute myocardial infarction Florence registry (AMI-Florence). Eur Heart J 24(13):1195–1203
European Association for Percutaneous Cardiovascular Interventions, Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization: the task force on myocardial revascularization of the european society of cardiology (ESC) and the european association for cardio-thoracic surgery (EACTS). Eur Heart J 31(20):2501–2555
Van de Werf F, Bax J, Betriu A et al (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European society of cardiology. Eur Heart J 29(23):2909–2945
Huggett AST, Nixon DA (1957) Use of glucose oxidase peroxidase and Odianisine in the determination of blood and urine glucose. Lancet 273:368–372
Hales CN, Randle PJ (1963) Immunoassay of insulin with insulin-antibody precipitate. Biochem J 88:137–144
Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612
Teichholz LE, Kreulen T, Herman MV, Gorlin R (1979) Problems in echocar-diographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy. Am J Cardiol 37:7–11
Balkau B, Charles M, For the European Group for the Study of Insulin Resistance (EGIR) (1999) Comment on the provisional report from the WHO consultation. Diabet Med 16:442–443
Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF (2011) Acute glucose dysmetabolism in the elderly with ST elevation myocardial infarction submitted to mechanical revascularization. Int J Cardiol Feb 21. [Epub ahead of print]
Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF (2011) Correlates of acute insulin resistance in the early phase of non-diabetic ST-elevation myocardial infarction. Diabetes Vasc Dis Res 8(1):35–42
Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF (2010) Acute glucose dysmetabolism in the early phase of ST-elevation myocardial infarction: the age response. Diabetes Vasc Dis Res 7(2):131–137
Knobl P, Schernthaner G, Schnack C et al (1994) Haemostatic abnormalities persist despite glycemia improvement by insulin therapy in lean type 2 diabetic patients. Thromb Haemost 71:692–697
Ceriello A (1993) Coagulation activation in diabetes mellitus: role of hyperglycemia in therapeutic prospects. Diabetologia 36:1119–1125
Marfella R, Siniscalchi M, Esposito K et al (2003) Effects of stress hyperglycemia on acute myocardial infarction. Diabetes 26:3129–3135
Zauner A, Nimmerrichter P, Anderwald C, Bishof M et al (2007) Severity of insulin resistance in critically ill medical patients. Metab Clin Exp 56:1–5
Young LH, Renfu Y, Russel R, Hu X et al (1997) Low-flow ischemia leads to translocation of canine heart GLUT-4 and GLUT-1 glucose transporters to the sarcolemma in vivo. Circulation 95:415–422
Garcia RG, Rincon MY, Arenas WD et al (2011) Hyperinsulinemia is a predictor of new cardiovascular events in Colombina patients with a first myocardial infarction. Int J Cardiol 148(1):85–90
Ceriello A, Zarich SW, Testa R (2009) Lowering glucose to prevent adverse cardiovascular outcomes in a critical care setting. JACC 53:S9–S13
Li L, Messina JL (2009) Acute insulin resistance following injury. Trend Endocrinol Metab 20:429–435
Lazzeri C, Valente S, Chiostri M, Picariello C, Gensini GF (2010) In-hospital peak glycemia and prognosis in STEMI patients without previously known diabetes. Eur J Cardiovasc Prev Rehabil 17(4):419–423
Holzinger U, Kitberger R, Furhmann V, Funk GC, Madl C, Ratheiser K (2007) Correlation of calculated indices of insulin resistance (QUICKI and HOMA) with the euglycaemic hyperinsulinaemic clamp technique for evaluating insulin resistance in critically ill patients. Eur J Anaesthesiol 24:966–970
Muniyappa R, Lee S, Chen H, Quon MJ (2008) Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab. 294(1):E15–E26
Basi S, Pupim LB, Simmons EM, Sezer MT, Shyr Y, Freedman S et al (2005) Insulin resistance in critically ill patients with acute renal failure. Am J Physiol Renal Physiol 289:F259–F264
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Lazzeri, C., Valente, S., Chiostri, M. et al. The glucose dysmetabolism in the acute phase of non-diabetic ST-elevation myocardial infarction: from insulin resistance to hyperglycemia. Acta Diabetol 50, 293–300 (2013). https://doi.org/10.1007/s00592-011-0325-6
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DOI: https://doi.org/10.1007/s00592-011-0325-6