Response to `Insulin therapy in acute coronary syndromes'

Abstract

Corresponding author: M de Mulder, Department of Cardiology, Medical Centre Alkmaar, The Netherlands. Tel: +31 725484444 Fax: +31 725482156 Email: m.de.mulder@mca.nl In the November 2008 issue of this journal Goyal et al. gave a good overview of past and present studies concerning glucose regulation in acute coronary syndromes. We would like to extend the observational overview with the BIOMArCS 2 glucose study. In July 2008 we started a single centre prospective randomised open-label clinical trial to systematically evaluate hyperglycaemia in ACS patients. We aim to randomise 300 ACS patients with an admission glucose > 7.7 mmol/L and no previous use of insulin. They either receive intensive or expectative hyperglycaemia management. In the intensive treatment group we aim for normoglycaemia using intravenous insulin; naturally caution is warranted to avoid hypoglycaemia. We hypothesise that systematic, frequent and intensive glucose level control, in those with abnormal levels, will improve LV haemodynamics; it will preserve myocardial tissue and LV function in ACS patients. We expect that the beneficial effects of this strategy will be modified by treatment delay (i.e. early treatment results in better outcomes), especially in ST segment elevation-ACS patients. Our primary endpoint is infarct size defined by cardiac Troponin T at 72 h after randomisation. Secondary endpoints include ST segment resolution, NT pro-BNP levels and LVEF and infarct size determined by using a 99mTc-sestamibi SPECT 6 weeks after randomisation. Furthermore we expect that the effects of intensive glucose level control will result in a more favourable wash out pattern of biomarkers of (vascular) inflammation, hypercoagulability and neurohumoral activation.