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The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012

John Birkhead, Clive Weston Orcid Logo, Adam Timmis, Ruoling Chen

European Heart Journal: Acute Cardiovascular Care, Volume: 4, Issue: 4, Pages: 344 - 352

Swansea University Author: Clive Weston Orcid Logo

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DOI (Published version): 10.1177/2048872614549733

Abstract

We compared 7 day survival for patients receiving IV insulin infusion (IVII) with those receiving routine care to control admission hyperglycaemia (>=11 mmol/l) in acute coronary syndrome.We used matched propensity analysis to examine observational data (2008-2012) from the Myocardial Ischaemia N...

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Published in: European Heart Journal: Acute Cardiovascular Care
ISSN: 2048-8726 2048-8734
Published: 2015
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URI: https://cronfa.swan.ac.uk/Record/cronfa18433
first_indexed 2014-09-16T02:00:11Z
last_indexed 2018-02-09T04:53:03Z
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recordtype SURis
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spelling 2017-04-24T11:09:58.0919947 v2 18433 2014-09-15 The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012 df85e4e0e139d0f46eb683174eba98a9 0000-0002-8995-8199 Clive Weston Clive Weston true false 2014-09-15 MEDS We compared 7 day survival for patients receiving IV insulin infusion (IVII) with those receiving routine care to control admission hyperglycaemia (>=11 mmol/l) in acute coronary syndrome.We used matched propensity analysis to examine observational data (2008-2012) from the Myocardial Ischaemia National Audit Project. We matched 5974 pairs of patients. We separately examined outcomes for ST elevation (STEMI) and non ST segment elevation (NSTEMI) infarctions, and those without known diabetes and those with type 2 diabetes. Survival benefit from the use of IVII was seen only in patients with STEMI not known to have diabetes at admission (adjusted hazard ratio (HR) 0.77 (95% confidence interval (CI) 0.64-0.92), p=0.005). Those with STEMI and existing type 2 diabetes who received IVII showed similar outcomes to routine care (HR 0.99 (95% CI 0.80-1.23), p=0.931). In patients with NSTEMI IVII was associated with significantly worse adjusted 7 day survival outcome than routine care, regardless of diabetes status; for those without known diabetes, HR 1.50 (95% CI 1.04-2.16), p=0.029, and for those with type 2 diabetes, HR 1.35 (95% CI 1.08-1.70), p=0.010.As used in current clinical practice to treat hyperglycaemia in acute coronary syndromes, IVII appears to be of benefit only for patients with STEMI who are not known to have diabetes. IVII is associated with adverse early outcomes in patients with NSTEMI. Journal Article European Heart Journal: Acute Cardiovascular Care 4 4 344 352 2048-8726 2048-8734 Acute Coronary syndrome; myocardial infarction; insulin; hyperglycaemia 8 9 2015 2015-09-08 10.1177/2048872614549733 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University 2017-04-24T11:09:58.0919947 2014-09-15T16:56:32.0286878 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine John Birkhead 1 Clive Weston 0000-0002-8995-8199 2 Adam Timmis 3 Ruoling Chen 4
title The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012
spellingShingle The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012
Clive Weston
title_short The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012
title_full The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012
title_fullStr The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012
title_full_unstemmed The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012
title_sort The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012
author_id_str_mv df85e4e0e139d0f46eb683174eba98a9
author_id_fullname_str_mv df85e4e0e139d0f46eb683174eba98a9_***_Clive Weston
author Clive Weston
author2 John Birkhead
Clive Weston
Adam Timmis
Ruoling Chen
format Journal article
container_title European Heart Journal: Acute Cardiovascular Care
container_volume 4
container_issue 4
container_start_page 344
publishDate 2015
institution Swansea University
issn 2048-8726
2048-8734
doi_str_mv 10.1177/2048872614549733
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 0
active_str 0
description We compared 7 day survival for patients receiving IV insulin infusion (IVII) with those receiving routine care to control admission hyperglycaemia (>=11 mmol/l) in acute coronary syndrome.We used matched propensity analysis to examine observational data (2008-2012) from the Myocardial Ischaemia National Audit Project. We matched 5974 pairs of patients. We separately examined outcomes for ST elevation (STEMI) and non ST segment elevation (NSTEMI) infarctions, and those without known diabetes and those with type 2 diabetes. Survival benefit from the use of IVII was seen only in patients with STEMI not known to have diabetes at admission (adjusted hazard ratio (HR) 0.77 (95% confidence interval (CI) 0.64-0.92), p=0.005). Those with STEMI and existing type 2 diabetes who received IVII showed similar outcomes to routine care (HR 0.99 (95% CI 0.80-1.23), p=0.931). In patients with NSTEMI IVII was associated with significantly worse adjusted 7 day survival outcome than routine care, regardless of diabetes status; for those without known diabetes, HR 1.50 (95% CI 1.04-2.16), p=0.029, and for those with type 2 diabetes, HR 1.35 (95% CI 1.08-1.70), p=0.010.As used in current clinical practice to treat hyperglycaemia in acute coronary syndromes, IVII appears to be of benefit only for patients with STEMI who are not known to have diabetes. IVII is associated with adverse early outcomes in patients with NSTEMI.
published_date 2015-09-08T12:36:47Z
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