Department of Cardiology, Medical Centre Alkmaar, Alkmaar, The Netherlands.
Diabet Med. 2011 Oct;28(10):1168-75. doi: 10.1111/j.1464-5491.2011.03307.x.
Elevated admission plasma glucose is associated with increased mortality in patients who are admitted with an acute coronary syndrome. This may be mediated by increased inflammation, apoptosis and coagulation, and by a disturbed endothelial function that can be found in hyperglycaemic patients. Insulin has several characteristics that may potentially counteract these mechanisms.
The BIOMArCS programme is a multi-centre initiative and currently consists of three different studies. The effects of acute coronary syndrome on acute biomarkers washout are studied in the BIOMArCS pilot and the value of biomarkers in predicting upcoming acute coronary syndrome events is studied in BIOMArCS 1. The third study (BIOMArCS 2 glucose), which will be presented here, investigates the effectiveness and safety of intensive glucose level control compared with conventional glucose management in patients with acute coronary syndrome and an admission plasma glucose of 7.8-16 mmol/l. In BIOMArCS 2 glucose, a total of 300 patients without insulin-treated diabetes mellitus will be randomized in a 1:1 ratio to either intensive or conventional glucose management on top of standard medical care. The primary endpoint is infarct size as expressed by the cardiac troponin T level 72 h after admission. To study the metabolic effects of insulin administration, we will investigate biomarker washout patterns of various metabolic mechanisms up to 7 days after admission. These markers will address inflammation, oxidative stress, hypercoagulability, endothelial activation and vasodilatation.
Current acute coronary syndrome guidelines lack a clear strategy for hyperglycaemia treatment. This study will extend our knowledge on this matter as it may clarify mechanisms and generate hypotheses of if and how myocardial infarct size may be limited by glucose management at admission.
入院时血糖升高与急性冠状动脉综合征患者的死亡率增加有关。这可能是由高血糖患者中存在的炎症、细胞凋亡和凝血增加以及内皮功能障碍所介导的。胰岛素具有几种可能对抗这些机制的特性。
BIOMArCS 计划是一项多中心倡议，目前由三项不同的研究组成。BIOMArCS 试验研究了急性冠状动脉综合征对急性生物标志物清除的影响，BIOMArCS 1 研究了生物标志物在预测即将发生的急性冠状动脉综合征事件中的价值。本研究（BIOMArCS 2 葡萄糖）将在此介绍，该研究旨在调查与常规血糖管理相比，强化血糖控制在入院血糖为 7.8-16mmol/L 的急性冠状动脉综合征患者中的有效性和安全性。在 BIOMArCS 2 葡萄糖中，将总共 300 例无胰岛素治疗的糖尿病患者随机分为强化血糖管理组和常规血糖管理组，两组均在标准医疗护理的基础上进行。主要终点是入院后 72 小时通过心肌肌钙蛋白 T 水平表达的梗死面积。为了研究胰岛素给药的代谢效应，我们将在入院后 7 天内研究各种代谢机制的生物标志物清除模式。这些标志物将涉及炎症、氧化应激、高凝状态、内皮激活和血管舒张。
目前的急性冠状动脉综合征指南缺乏明确的高血糖治疗策略。这项研究将扩展我们对此问题的认识，因为它可能阐明机制，并产生关于心肌梗死面积是否可以通过入院时的血糖管理来限制的假设。
