Acute Kidney Injury The risk of renal failure with STEMI relates to a host of factors, including patient age, prehospital renal function, medications, contrast volume, and hemodynamic status. Contrast-induced nephropathy after angiography and intervention for STEMI is always a risk, and attention to minimization of contrast vol- ume and optimal hydration is required.219 There is a U-shaped relationship between glucose levels and death in STEMI andACS.567 The mortality rate associated with hypoglycemia appears to be as high as the mortality rate asso- ciated with hyperglycemia.568,569 Concern about overly aggres- sive glycemic control in critically ill patients was raised by the NICE-SUGAR (Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation) trial.570 In this study of medical and surgical intensive care unit patients, tight glucose control (81 to 108 mg/dL) compared to modest control (<180 mg/dL) was associated with increased mortality rate (primarily from cardiovascular causes) and more episodes of hypoglycemia. Blood glucose levels should be maintained below 180 mg/dL if possible while avoiding hypoglycemia. There is no established role for glucose-insulin-potassium infusions in patients with STEMI.571 573 10. Risk Assessment After STEMI Initial risk stratification should be performed early (Section 3) with the use of information available at the time of pre- sentation. However, risk assessment is a continuous process that requires recalibration on the basis of data obtained dur- ing the hospital stay. Such data include the success of reper- fusion therapy, events that occur during the hospital course (such as hemorrhagic complications), and the findings from noninvasive and invasive testing, particularly as they relate to the assessment of LV systolic function. 