Admission Hyperglycemia and Acute Myocardial Infarction: Outcomes and Potential Therapies for Diabetics and Nondiabetics

Table 2

Recommendations for intensive glucose control in STEMI.

2004/2005/2007 recommendations: 2004 STEMI guidelines	2009 joint STEMI/PCI focused update recommendations	Comments
Class I
(1) An insulin infusion to normalize blood glucose is recommended for patients with STEMI and complicated courses (level of evidence: B).		Recommendation is no longer current. See 2009 Class IIa recommendation no. 1.
Class IIa
	(1) It is reasonable to use an insulin-based regimen to achieve and maintain glucose levels less than 180 mg/dL while avoiding hypoglycemia* for patients with STEMI with either a complicated or uncomplicated course (16, 94–96) (level of evidence: B).	New recommendation
(1) During the acute phase (first 24 to 48 hours) of the management of STEMI in patients with hyperglycemia, it is reasonable to administer an insulin infusion to normalize blood glucose even in patients with an uncomplicated course (level of evidence: B).		Recommendation is no longer current. See 2009 Class IIa recommendation no. 1.

^*There is uncertainty about the ideal target range for glixose necessary to achieve an optimal risk-benefit ratio.
Recommendations for Intensive Glucose Control in STEMI.
Table from [20].