- Original article
- Open access
- Published:
Admission insulin resistance index in nondiabetic patients with acute coronary syndrome: clinical and angiographic features
The Egyptian Journal of Internal Medicine volume 25, pages 42–46 (2013)
Abstract
Background
The clinical implication of insulin resistance has extended beyond diabetes mellitus to include ischemic heart disease, dyslipidemia, hypertension, and features of metabolic syndrome. Nondiabetic patients with acute coronary syndrome and elevated admission insulin resistance index (AIRI) may have certain clinical angiographic and therapeutic strategies.
Objectives
The study aimed to illustrate the value of AIRI in nondiabetic patients with acute coronary syndrome and identify the angiographic coronary artery disease severity in relation to AIRI.
Study design
This study was cross-sectional in design.
Patients and methods
This study included 120 nondiabetic patients presenting with acute chest pain who were admitted to the coronary care unit. Admission glucose and insulin concentrations were measured and the AIRI was calculated. ECG was carried out and the patients were grouped as follows: those with unstable angina (UA) (40 cases) and those with acute myocardial infarction (AMI) (40 cases). They were compared with 40 patients with stable angina (SA) and a group of controls (40 individuals). The studied participants were examined clinically stressing on the other criteria for insulin resistance syndrome. The following laboratory tests were undertaken, including random plasma glucose, HBA1-c, lipid profile, cardiac enzymes (CK-MB, LDH), and troponin T. An angiographic study was carried out for patients from each diseased group and for 20 patients who had suffered a first attack in the SA group.
Results
AIRI was significantly elevated in the AMI (3.9 ± 0.1) and UA (3.01 ± 0.2) groups when compared with the SA and control groups. AIRI was significantly higher in the AMI group when compared with the UA group. Coronary angiography revealed one coronary vessel involvement in 10, 20, and 10% of patients in the SA, UA, and AMI groups, respectively, whereas two-vessel involvement was detected in 0, 30, and 60% of patients in the SA, UA, and AMI groups, respectively. Three-coronary-vessel disease was not detected in the SA group but was evident in 5% of UA and 30% of AMI patients. The relation of AIRI in the studied groups on the basis of the χ2-test revealed significant elevation of AIRI in the AMI and UA groups. Cases with three-vessel affection demonstrated higher AIRI.
Conclusion
Elevated AIRI can predict coronary artery events in nondiabetic patients with acute chest pain. Multiple coronary vessel involvement is common in such cases and suitable planned invasive therapeutic strategies have to be considered.
References
Miller AM, Alcaraz Ruiz A, Borrayo Sánchez G, Almeida Gutié rrez E, Vargas Guzmán RM, Jáuregui Aguilar R. Metabolic syndrome: clinical and angio-graphic impact on patients with acutecoronary syndrome. Cir Cir 2010; 78:113–120.
Stern SE, Williams K, Ferrannini E, DeFronzo RA, Bogardus C, Stern MP. Identification of individuals with insulin resistance using routine clinical measurements. Diabetes 2005; 54:333–339.
Stuhlinger MC, Abbasi F, Chu JW. Relationship between insulin resistance and an endogenous nitric oxide synthase inhibitor. JAMA 2002; 287:1420–1526.
Reaven, GM. Syndrome X insulin resistance, hyperinsulineamia and coronary heart disease in diabetes and carbohydrate metabolism. Chapter 28 In: Goldfine ID, Rushakoff RJ, editors. Role of insulin resistance in human disease. Diabetes 1988; 37:1595–1607.
Clavijo LC, Pinto TL, Kuchulakanti PK, Torguson R, Chu WW, Satler LF, et al. Metabolic syndrome in patients with acute myocardial infarction is associated with increased infarct size and in-hospital complications. Cardiovasc Revasc Med 2006; 7:7–11.
Sinha DP, Ahmed S, Baneerjee AK, Das M, Hassan H. Significance of an index of insulin resistance in non-diabetic patients with impaired fasting glucose with acute myocardial infarction and its correlation to short term outcome. Indian Heart J 2009; 61:40–43.
Stubbs PJ, Alaghband-Zadeh J, Laycock JF, Collinson PO, Carter GD, Noble MI. Significance of an index of insulin resistance on admission in non-diabetic patients with acute coronary syndromes. Heart 1999; 82: 443–447.
Matthews DR, Hosker JP, Rudenski JS, Naylor BA, Treacher DF, Turner RC, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28:412–419.
Kragelund C, Snorgaard O, Kober L. Hyperinsulinaemia is associated with increased long term mortality following acute myocardial infarction in non-diabetic patients. Eur Heart J 2004; 25:1891– 1897.
Yoon SE, Ahn SG, Kim JY, Park JS, Shin JH, Tahk SJ, et al. Differential relationship between metabolic syndrome score and severity of coronary atherosclerosis as assessed by angiography in a non-diabetic and diabetic korean population. J Korean Med Sci 2011; 26:900–905.
Arslan U, Türkoğlu S, Balcioğlu S, Tavil Y, Karakan T, Cengel A. Association between nonalcoholic fatty liver disease and coronary artery disease. Coron Artery Dis 2007; 18:433–436.
Caccamo G, Bonura F, Bonura F, Vitale G, Novo G, Evola S, et al. Insulin resistance and acute coronary syndrome. Atherosclerosis 2010; 211: 672–675.
Esam N, Mohamed A, Ghonemy A, Yasser A, Elhendy A, Nader M. Value of admission insulin resistance index application to non- diabetics with acute coronary syndromes. 15th Zagazig Annual Medical Conference. Zagazig Univ Med J 2007; 104–116.
Executive Summary of the Third Report of The National Cholesterol Education Program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment PANEL III). JAMA 2001; 285:2486–2487.
Cefalu WT, Wang ZQ, Werbel S. Contribution of visceral fat mass to insulin resistance of aging. Metabolism 1995; 44:954–959.
Mc Farlane IS, Maryann B, Sowers JR. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab 2001; 86:713–718.
Michinori I. Hypertension and insulin disorders. Curr Hypertens Rep 2002; 4:477–482.
Campbell PJ, Gerich JE. Impact of obesity on insulin action in volunteers with normal glucose tolerance: demonstration of the threshold for adverse effect of obesity. J Clin Endocrinol Metab 1993; 70:1114–1118.
Reaven GM, Bernstein R, Davis B. Coronary heart disease in the absence of hypercholesterolaemia. J Intern Med 2000; 236:415–417.
Reaven GM. Role of insulin resistance in human disease (syndrome X): an expanded definition. Annu Rev Med 1993; 44:121–131.
Malmberg K, Ryden L, Efendic S, Herlitz J, Nicol P, Waldenström A, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol 1995; 26:57–65.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Refaie, W., Elewa, A. Admission insulin resistance index in nondiabetic patients with acute coronary syndrome: clinical and angiographic features. Egypt J Intern Med 25, 42–46 (2013). https://doi.org/10.7123/01.EJIM.0000425959.76987.c5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.7123/01.EJIM.0000425959.76987.c5