Influence of Bedside Blood Insulin Measurement on Acute Coronary Syndrome Pathways

Panza-Nduli, José; Coulic, Very; Willems, Dominique; Devriendt, Jacques; Gottignies, Philippe; Staroukine, Michel; Bels, David De

doi:10.1097/hpc.0b013e318238c5ca

Cited by 6 publications

(9 citation statements)

References 19 publications

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“…Hyperglycemia in STEMI patients has direct acute negative cardiovascular effects contributing to incomplete myocardial reperfusion and CMF impairment [ 24 - 28 ]. The prognostic relevance of hyperinsulinemia in STEMI patients [ 29 , 30 ] and its relationship with coronary flow [ 31 ] are less well evaluated and acknowledged.…”

Section: Introductionmentioning

confidence: 99%

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Trifunović

Stanković

Šobić-Šaranović

et al. 2014

Cardiovasc Diabetol

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BackgroundInsulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI).MethodsIn 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2nd and 7th day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2nd day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices.ResultsIR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (p = 0.001) and day 7 (p < 0.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (r = 0.331), whereas both HOMA indices correlated well with CFR (r = -0.331 to -0.386) (p < 0.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2 mm (OR 11.70, 95% CI 2.46-55.51, p = 0.002) and CFR < 2 (OR = 5.98, 95% CI 1.88-19.03, p = 0.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, p = 0.026).ConclusionIR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size.

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Section: Introductionmentioning

confidence: 99%

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Trifunović

Stanković

Šobić-Šaranović

et al. 2014

Cardiovasc Diabetol

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“…Venous hyperglycaemia may be the consequence of different alterations of insulin production/utilization but also of other mechanisms and factors influencing the glucose metabolism. 17,18 In such patients insulin administration would not be always pertinent: as already noted, observation of a too strict glycaemia regimen is known to be sometimes dangerous. [3][4][5][6] The levels of central glycaemia and their evolution could be an indicator of the liver function as well, at least partly.…”

Section: Discussionmentioning

confidence: 99%

Glucose measure in arterial or in venous blood

Coulic¹,

Dobos²,

Новиков³

2018

EMIJ

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“…This would be confirmed by some clinical observations in ICU which have shown that the reported hyperglycaemia could correspond to different levels of blood insulin contents. 12 In animals after anaesthesia and surgery, temporary hyperglycaemia was more frequent and more important, than after anaesthesia only. This was probably due to the influence of intubation and operative stress, and corresponds to literature data concerning acute critical care.…”

Section: Discussionmentioning

confidence: 99%

“…It is also well known that acute situations in critically ill or post-operation patients have a significant influence on their glycaemia levels. [5][6][7][8][9][10][11][12] However the link between these two factors does not seem to have been established though the part of glucose utilization in the heath production of the organism is known to be about 70%. 13 Recently new possibilities of approaching the investigation of the heath loss during surgery has appeared thanks to a new device called ADD (apparatus for diabetes diagnosis) which continuously registers core/deep (Tc) and superficial (Ts) temperatures of the body and their difference (Tc-Ts=dT).…”

Section: Introductionmentioning

confidence: 99%

Anaesthesia Influence on Glycaemia and Body Temperatures (First Results)

Coulic¹

2018

EMIJ

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Background: The negative effect of the patient's temperature decrease is well known among surgeons and anaesthesiologists. The influence of critical situations including operation stress on glycaemia levels and evolution was also reported. The link between the two factors has remained rather unclear. Disposing a device/ ADD/ allowing the continuous measure of core/deep and superficial body temperatures and their difference (dT) evolution we have tried to differentiate the role of anaesthesia and surgery in glycaemia and temperature evolution in rats and humans. Method: 40rats were used and investigated during and immediately after anaesthesia alone and after thoracic surgery under the same anaesthesia. A group of 5 healthy not anesthetized volunteers and 5 informed consenting patients undergoing digestive surgery was also investigated. ADD was used for temperature measures, pH meter or strips-for glycaemia measure. Endocrinology & Metabolism International Journal Research Article Open Access Results: Use of ADD device composed of 2 digital temperature captors, an analysing processor and registrar has allowed a continuous recording of the temperature regimen of the body and has shown that anaesthesia by itself can lead to significant hypothermia and to death if correction is not provided. Glycaemia levels varied in different ways: without correction they could dangerously either increase or decrease. Their decrease under normal level was a bad prognostic sign. Correlation between glycaemia and dT was not evident. Surgery has only deepened the effect of anaesthesia. In clinics the described effects were less expressed because of permanent empiric correction. Conclusion: Anaesthesia and surgical intervention were confirmed to influence significantly glucose metabolism and energetics of the body. ADD device can be used as a testimony of temperature production and release that is of energetic balance of the organism. The dT continuous registration, besides glycaemia levels recording may be the basis for an adequate and quick monitoring of the patient's condition.

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Influence of Bedside Blood Insulin Measurement on Acute Coronary Syndrome Pathways

Cited by 6 publications

References 19 publications

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

Glucose measure in arterial or in venous blood

Anaesthesia Influence on Glycaemia and Body Temperatures (First Results)

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