Determinants of C-peptide levels and acute insulin resistance/sensitivity in nondiabetic STEMI role of Killip class

Publication date: March 2014 Source:IJC Metabolic & Endocrine, Volume 2 Author(s): Chiara Lazzeri , Serafina Valente , Maria Grazia D'Alfonso , Marco Chiostri , Gian Franco Gensini The alterations in glucose homeostasis in the early phase of nondiabetic ST-elevation myocardial infarction (STEMI) are complex, involving not only hyperglycemia but also the development of acute insulin resistance (as part of the stress response) as assessed by the Homeostatic Model Assessment index (HOMA). No data is so far available on C-peptide values in the acute phase of STEMI in patients without previously known diabetes. The aims of the present investigation, performed in 782 consecutive STEMI patients without previously known diabetes, were as follows: a) to assess the determinants of C-peptide levels; b) to address the relation between acute insulin-resistance and Killip class; and c) to investigate the prognostic role of C-peptide for early mortality. In our series, 729 patients (93.2%) were in Killip I–II (group A), while 53 patients (6.8%) were in Killip classes III–IV (group B). Group B showed higher levels of admission glycemia, insulin and C-peptide (p<0.001, p=.022 and p<0.001 respectively), together with higher values of HOMA-index and log-HOMA (p<0.001 and p<0.001, respectively) and reduced HOMA-%B (p=0.014). Left ventricular ejection fraction was inversely correlated with C-peptide, insulin and admission glycemia (p<0.001, ...
Source: IJC Metabolic and Endocrine - Category: Endocrinology Source Type: research