Hyperglycaemia in Acute Coronary Syndrome: an unsolved problem in clinical medicine

*Calin Pop¹, Marcel Pop², Lavinia Pop¹

Summary
Acute or stress hyperglycaemia represents the transient elevation of the blood glucose level due to the activation of neurohormonal mechanisms in organisms exposed to stress. An abnormal prevalence of glycosuria in patients with acute coronary syndrome (ACS) had been reported as early as 1931 but it was only in 1975 that an abnormally high level of glycaemia following acute myocardial infarction (AMI) was noted to represent an aggravating factor affecting prognosis.
Acute hyperglycaemia induced hazards regarding ACS prognosis can be explained by the prevalence of insulin resistance syndrome in these patients, irrespective of the presence or absence of diabetes mellitus (DM), while clinical trials clearly highlight the fact that intensive glycaemic control reduces mortality rate in patients with a critical state of different illnesses, lessens the deterioration of renal function and cuts cardiovascular risk in patients with ACS. Glycaemic control in hyperglycaemia patients with ACS can be carried out by using a metabolic mixture containing a glucose-insulin-potassium mixture (GIK) independent of the glucose level status, or better by optimized insulin therapy. Proper achievement of the standardized protocol is imperative for obtaining optimal glycaemic levels and minimizing hypoglycaemia risks, especially in patients who develop ACS. Ongoing studies and trials will provide new elements and information that will improve the evolution and prognosis of patients with ACS and hyperglycaemia.

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