Management of hyperglycaemia in acute coronary syndrome

Abstract

To review the management of blood glucose in acute coronary syndrome (ACS) a literature search was undertaken using Medline and Embase databases (January 1950-July 2008), bibliographies of retrieved articles, review articles and Department of Health reports. Trials were eligible for inclusion in the review if they (i) included patients with ACS and hyperglycaemia with or without diabetes or compared insulin infusion or glucose-potassium-insulin infusion with active controls, (ii) were randomised, and (iii) assessed mortality and morbidity. Eight trials met the above criteria (two of which have yet to report). Only two of the remaining six trials reported that insulin therapy significantly reduces mortality in ACS patients with hypergly- caemia. In conclusion ACS is of major public health importance in the UK and hyperglycaemia in the setting of ACS is associated with worse outcome. Current variability in management of blood glucose in ACS reflects a paucity of robust evidence to guide practice. Two ongoing trials may resolve the uncertainty about optimum blood glucose management in ACS. © The Author(s), 2010.