scholarly journals An Overview of Glycemic Control in the Coronary Care Unit with Recommendations for Clinical Management

2009 ◽  
Vol 3 (6) ◽  
pp. 1342-1351 ◽  
Author(s):  
Mikhail Kosiborod ◽  
Prakash Deedwania
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Coronary Care Unit ◽  
Elevated Glucose ◽  
Coronary Syndromes ◽  
Coronary Care ◽  
Glucose Management ◽  
The Relationship ◽  
Intense Debate

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.

Abstract 3166: Blood Transfusion and Clinical Outcomes in Patients with Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Doron Aronson ◽  
Michael Kapeliovich ◽  
Walter Markiewicz ◽  
Haim Hammerman
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
Interquartile Range ◽  
Killip Class ◽  
Coronary Syndromes ◽  
To Receive ◽  
The Relationship ◽  
Baseline Hemoglobin

Introduction: The safety of red blood cells transfusion (RBC-T) in patients (pts) with acute coronary syndromes is controversial, with some studies suggesting that RBC-T may adversely affect outcome. Methods: We studied the relationship between RBC-T during hospitalization and 6-months mortality in 2325 pts with acute myocardial infarction (AMI).Propensity score for RBC-T was calculated based on a logistic regression model incorporating age, sex, baseline hemoglobin (Hb), creatinine, diabetes, smoking, blood pressure and heart rate, Killip class, thrombolytic therapy and coronary interventions. The association between RBC-T and mortality was assessed using Cox mode with RBC-T as a time-dependent covariate, adjusting for the propensity to receive RBC-T and nadir Hb prior to RBC-T. Results: One hundred and ninety one pts (8.2%) received RBC-T. Median nadir Hb was markedly lower in pts receiving RBC-T (8.8 gr/dL [interquartile range 8.2–9.3]) compared with pts not receiving RBC-T (12.8 gr/dL [interquartile range 11.6 –13.9]; P < 0.0001). Mortality increased progressively in pts receiving RBC-T over the 6-months follow-up (Figure ). The unadjusted hazard ratio (HR) for mortality in pts receiving RBC-T was 4.1 (95% CI 3.0 –5.7, P < 0.0001). The effect of RBC-T was attenuated but remained significant after adjustments for the propensity to receive RBC-T (HR 2.1; 95% CI 1.4 –3.2, P < 0.0001). However, after adjusting for nadir Hb, the association between RBC-T and mortality was not significant (HR 1.4; 95% 0.9 –2.1, P = 0.09). Conclusion: The transfusion-associated risk in patients with AMI reflects the severity of the anemia at the time of transfusion and associated comorbidities.

Management of Ventricular Fibrillation during Acute Myocardial Infarction

1984 ◽  
Vol 23 (04) ◽  
pp. 209-213
Author(s):  
B. J. Northover
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Fibrillation ◽  
Coronary Care Unit ◽  
Patient Survival ◽  
Left Ventricular ◽  
Ventricular Failure ◽  
Before And After ◽  
Coronary Care ◽  
The Creation

SummaryAnalysis of electrocardiograms tape-recorded from patients admitted to hospital with acute myocardial infarction revealed that the pattern of ventricular extrasystolic activity was not significantly different among those who subsequently developed ventricular fibrillation and those who did not. Episodes of ventricular fibrillation occurred predominantly within 4 hours from the start of infarction. Patients were 3 times less likely to survive an episode of ventricular fibrillation if they also had left ventricular failure than if this feature was absent. Management of episodes of ventricular fibrillation was compared in patients before and after the creation of a specially staffed and equipped coronary care unit. The success of electric shock as a treatment for ventricular fibrillation was similar before and after the creation of the coronary care unit. An attempt was made to determine which features in the management of ventricular fibrillation in this and in previously published series were associated with patient survival.

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