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Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry

BACKGROUND: Hyperglycaemia occurs frequently in ST‐elevation myocardial infarction (STEMI) and is associated with poor outcomes, for which continuous insulin infusion therapy (CIIT) may be beneficial. Information is limited regarding hyperglycaemia in acute STEMI affecting urban minority populations...

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Autores principales: Shitole, Sanyog G., Srinivas, Vankeepuram, Berkowitz, Julia L., Shah, Tina, Park, Michael J., Herzig, Samuel, Christian, Anne, Patel, Neeral, Xue, Xiaonan, Scheuer, James, Kizer, Jorge R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947698/
https://www.ncbi.nlm.nih.gov/pubmed/31922020
http://dx.doi.org/10.1002/edm2.89
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author Shitole, Sanyog G.
Srinivas, Vankeepuram
Berkowitz, Julia L.
Shah, Tina
Park, Michael J.
Herzig, Samuel
Christian, Anne
Patel, Neeral
Xue, Xiaonan
Scheuer, James
Kizer, Jorge R.
author_facet Shitole, Sanyog G.
Srinivas, Vankeepuram
Berkowitz, Julia L.
Shah, Tina
Park, Michael J.
Herzig, Samuel
Christian, Anne
Patel, Neeral
Xue, Xiaonan
Scheuer, James
Kizer, Jorge R.
author_sort Shitole, Sanyog G.
collection PubMed
description BACKGROUND: Hyperglycaemia occurs frequently in ST‐elevation myocardial infarction (STEMI) and is associated with poor outcomes, for which continuous insulin infusion therapy (CIIT) may be beneficial. Information is limited regarding hyperglycaemia in acute STEMI affecting urban minority populations, or how CIIT fares in such real‐world settings. METHODS AND RESULTS: We assembled an acute STEMI registry at an inner‐city health system, focusing on patients with initial blood glucose ≥180 mg/dL to determine the impact of CIIT vs usual care. Clinical and outcomes data were added through linkage to electronic records. Inverse‐probability‐of‐treatment weighting using propensity scores (PS) was used to compare CIIT vs no CIIT. The 1067 patients included were mostly Hispanic or African American; 356 had blood glucose ≥180 mg/dL. Such pronounced hyperglycaemia was related to female sex, minority race‐ethnicity and lower socioeconomic score, and associated with increased death and death or CVD readmission. CIIT was preferentially used in patients with marked hyperglycaemia and was associated with in‐hospital hypoglycaemia (21% vs 11%, P = .019) and, after PS weighting, with increased in‐hospital (RR 3.23, 95% CI 0.94, 11.06) and 1‐year (RR 2.26, 95% CI 1.02, 4.98) mortality. No significant differences were observed for death at 30 days or throughout follow‐up, or death and readmission at any time point. CONCLUSIONS: Pronounced hyperglycaemia was common and associated with adverse prognosis in this urban population. CIIT met with selective use and was associated with hypoglycaemia, together with increased mortality at specific time points. Given the burden of metabolic disease, particularly among race‐ethnic minorities, assessing the benefits of CIIT is a prerogative that requires evaluation in large‐scale randomized trials.
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spelling pubmed-69476982020-01-09 Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry Shitole, Sanyog G. Srinivas, Vankeepuram Berkowitz, Julia L. Shah, Tina Park, Michael J. Herzig, Samuel Christian, Anne Patel, Neeral Xue, Xiaonan Scheuer, James Kizer, Jorge R. Endocrinol Diabetes Metab Original Articles BACKGROUND: Hyperglycaemia occurs frequently in ST‐elevation myocardial infarction (STEMI) and is associated with poor outcomes, for which continuous insulin infusion therapy (CIIT) may be beneficial. Information is limited regarding hyperglycaemia in acute STEMI affecting urban minority populations, or how CIIT fares in such real‐world settings. METHODS AND RESULTS: We assembled an acute STEMI registry at an inner‐city health system, focusing on patients with initial blood glucose ≥180 mg/dL to determine the impact of CIIT vs usual care. Clinical and outcomes data were added through linkage to electronic records. Inverse‐probability‐of‐treatment weighting using propensity scores (PS) was used to compare CIIT vs no CIIT. The 1067 patients included were mostly Hispanic or African American; 356 had blood glucose ≥180 mg/dL. Such pronounced hyperglycaemia was related to female sex, minority race‐ethnicity and lower socioeconomic score, and associated with increased death and death or CVD readmission. CIIT was preferentially used in patients with marked hyperglycaemia and was associated with in‐hospital hypoglycaemia (21% vs 11%, P = .019) and, after PS weighting, with increased in‐hospital (RR 3.23, 95% CI 0.94, 11.06) and 1‐year (RR 2.26, 95% CI 1.02, 4.98) mortality. No significant differences were observed for death at 30 days or throughout follow‐up, or death and readmission at any time point. CONCLUSIONS: Pronounced hyperglycaemia was common and associated with adverse prognosis in this urban population. CIIT met with selective use and was associated with hypoglycaemia, together with increased mortality at specific time points. Given the burden of metabolic disease, particularly among race‐ethnic minorities, assessing the benefits of CIIT is a prerogative that requires evaluation in large‐scale randomized trials. John Wiley and Sons Inc. 2019-08-14 /pmc/articles/PMC6947698/ /pubmed/31922020 http://dx.doi.org/10.1002/edm2.89 Text en © 2019 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Shitole, Sanyog G.
Srinivas, Vankeepuram
Berkowitz, Julia L.
Shah, Tina
Park, Michael J.
Herzig, Samuel
Christian, Anne
Patel, Neeral
Xue, Xiaonan
Scheuer, James
Kizer, Jorge R.
Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry
title Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry
title_full Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry
title_fullStr Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry
title_full_unstemmed Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry
title_short Hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute ST‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: The Montefiore STEMI Registry
title_sort hyperglycaemia, adverse outcomes and impact of intravenous insulin therapy in patients presenting with acute st‐elevation myocardial infarction in a socioeconomically disadvantaged urban setting: the montefiore stemi registry
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947698/
https://www.ncbi.nlm.nih.gov/pubmed/31922020
http://dx.doi.org/10.1002/edm2.89
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