The acute coronary syndrome revisited: effects and therapeutic modulation of excess metabolic fuel supply

Our proposal is that that metabolic perturbations occurring during and after the onset of the acute coronary syndrome (ACS) require careful management from the moment patients with this diagnosis are admitted to the intensive care unit (ICU). We advocate that insulin treatment should be initiated when blood glucose levels rise to above 11 mM (or 200 mg/dl), thereby providing additional therapeutic benefits. The reasons are as follows