An overview of glycemic control in the coronary care unit with recommendations for clinical management

Abstract

The observation that elevated glucose occurs frequently in the setting of acute myocardial infarction was made decades ago. Since then numerous studies have documented that hyperglycemia is a powerful risk factor for increased mortality and in-hospital complications in patients with acute coronary syndromes. While some questions in this field have been answered in prior investigations, many critical gaps in knowledge continue to exist and remain subjects of intense debate. This review summarizes what is known about the relationship between hyperglycemia, glucose control, and outcomes in critically ill patients with acute coronary syndromes, addresses the gaps in knowledge and controversies, and offers general recommendations regarding glucose management in the coronary care unit.

Figure 1.

Relationship between admission glucose levels and mortality at 30 days and 1 year in patients with AMI. Reproduced with permission from Circulation.

Figure 2.

Relationship between average glucose levels during hospitalization and in-hospital mortality in patients with AMI after multivariable adjustment (reference: mean blood glucose 100 to <100). Reproduced with permission from Circulation.

Figure 3.

Association between glucose normalization and risk of death during AMI hospitalization. Reproduced with permission from Archives of Internal Medicine.

Figure 4.

Association between admission glucose and mortality at 30 days (A) and 1 year (B) in patients hospitalized with HF. Reproduced with permission from Circulation.