(Circulation. 1999;99:2626-2632.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Glycometabolic State at Admission: Important Risk Marker of Mortality in Conventionally Treated Patients With Diabetes Mellitus and Acute Myocardial Infarction
Long-Term Results From the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Study
From the Department of Cardiology, Karolinska Hospital (K.M., A.N., L.R.), Stockholm, and Nordic School for Public Health (H.W.), Göteborg, Sweden.
Correspondence to Lars Rydén, MD, Department of Cardiology, Karolinska Hospital, S-171 76 Stockholm, Sweden.
Background—The Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study addressed prognostic factors and the effects of concomitant treatment and glycometabolic control in diabetic patients with myocardial infarction (AMI).
Methods and Results—Of 620 diabetic patients with AMI, 306 were
randomly assigned to a 
24-hour insulin-glucose infusion
followed by multidose subcutaneous insulin. Three hundred fourteen
patients were randomized as controls, receiving routine antidiabetic
therapy. Thrombolysis and ß-blockers were administered
when possible. Univariate and multivariate
statistical analyses were applied to study predictors of
long-term mortality. During an average follow-up of 3.4 years (range,
1.6 to 5.6 years), 102 patients (33%) in the intensive insulin group
and 138 (44%) in the control group died (P=0.011). Old
age, previous heart failure, diabetes duration, admission blood
glucose, and admission Hb AIc were independent predictors
of mortality in the total cohort, whereas previous AMI, hypertension,
smoking, or female sex did not add independent predictive value.
Metabolic control, mirrored by blood glucose and Hb
AIc, improved significantly more in patients on intensive
insulin treatment than in the control group. ß-Blockers improved
survival in control subjects, whereas thrombolysis was
most efficient in the intensive insulin group.
Conclusions—Mortality in diabetic patients with AMI is predicted by age, previous heart failure, and severity of the glycometabolic state at admission but not by conventional risk factors or sex. Intensive insulin treatment reduced long-term mortality despite high admission blood glucose and Hb AIc.
Key Words: myocardial infarction • diabetes mellitus • mortality • morbidity • glucose • insulin
This article has been cited by other articles:
 |
|
 |
|
  P. Deedwania, M. Kosiborod, E. Barrett, A. Ceriello, W. Isley, T. Mazzone, and P. Raskin Hyperglycemia and Acute Coronary Syndrome: A Scientific Statement From the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism Circulation, March 25, 2008; 117(12): 1610 - 1619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. W. Nesto and R. M. Lago Glucose: A Biomarker in Acute Myocardial Infarction Ready for Prime Time? Circulation, February 26, 2008; 117(8): 990 - 992. [Full Text] [PDF]
|
|
|
|
|
|
M. Kosiborod, S. E. Inzucchi, H. M. Krumholz, L. Xiao, P. G. Jones, S. Fiske, F. A. Masoudi, S. P. Marso, and J. A. Spertus Glucometrics in Patients Hospitalized With Acute Myocardial Infarction: Defining the Optimal Outcomes-Based Measure of Risk Circulation, February 26, 2008; 117(8): 1018 - 1027. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Mellbin, K. Malmberg, A. Norhammar, H. Wedel, L. Ryden, and for the DIGAMI 2 Investigators The impact of glucose lowering treatment on long-term prognosis in patients with type 2 diabetes and myocardial infarction: a report from the DIGAMI 2 trial Eur. Heart J., January 2, 2008; 29(2): 166 - 176. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Fernandez, C. Triplitt, E. Wajcberg, A. A. Sriwijilkamol, N. Musi, K. Cusi, R. DeFronzo, and E. Cersosimo Addition of Pioglitazone and Ramipril to Intensive Insulin Therapy in Type 2 Diabetic Patients Improves Vascular Dysfunction by Different Mechanisms Diabetes Care, January 1, 2008; 31(1): 121 - 127. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Ballweg, G. Wernovsky, R. F. Ittenbach, J. Bernbaum, M. Gerdes, P. R. Gallagher, T. E. Dominguez, E. Zackai, R. R. Clancy, S. C. Nicolson, et al. Hyperglycemia After Infant Cardiac Surgery Does Not Adversely Impact Neurodevelopmental Outcome Ann. Thorac. Surg., December 1, 2007; 84(6): 2052 - 2058. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Norhammar, J. Lindback, L. Ryden, L. Wallentin, U. Stenestrand, and on behalf of the Register of Information and Knowl Improved but still high short- and long-term mortality rates after myocardial infarction in patients with diabetes mellitus: a time-trend report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission Heart, December 1, 2007; 93(12): 1577 - 1583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Weston, L Walker, J Birkhead, and National Audit of Myocardial Infarction Project, N Early impact of insulin treatment on mortality for hyperglycaemic patients without known diabetes who present with an acute coronary syndrome Heart, December 1, 2007; 93(12): 1542 - 1546. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Asadollahi, N. Beeching, and G. Gill Hyperglycaemia and mortality J R Soc Med, November 1, 2007; 100(11): 503 - 507. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. W. Zarich and R. W. Nesto Implications and Treatment of Acute Hyperglycemia in the Setting of Acute Myocardial Infarction Circulation, May 8, 2007; 115(18): e436 - e439. [Full Text] [PDF]
|
|
|
|
|
|
K. K. Ray, C. P. Cannon, D. A. Morrow, A. J. Kirtane, J. Buros, N. Rifai, C. H. McCabe, C. M. Gibson, and E. Braunwald Synergistic relationship between hyperglycaemia and inflammation with respect to clinical outcomes in non-ST-elevation acute coronary syndromes: analyses from OPUS-TIMI 16 and TACTICS-TIMI 18 Eur. Heart J., April 2, 2007; (2007) ehm010v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Inzucchi Management of Hyperglycemia in the Hospital Setting N. Engl. J. Med., November 2, 2006; 355(18): 1903 - 1911. [Full Text] [PDF]
|
|
|
|
|
|
D.-Y. Hu, C.-Y. Pan, J.-M. Yu, and for the China Heart Survey Group The relationship between coronary artery disease and abnormal glucose regulation in China: the China Heart Survey Eur. Heart J., November 1, 2006; 27(21): 2573 - 2579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ishihara, I. Inoue, T. Kawagoe, Y. Shimatani, S. Kurisu, T. Hata, Y. Nakama, Y. Kijima, and E. Kagawa Is admission hyperglycaemia in non-diabetic patients with acute myocardial infarction a surrogate for previously undiagnosed abnormal glucose tolerance? Eur. Heart J., October 2, 2006; 27(20): 2413 - 2419. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. A. Smit and J. A. Romijn Acute insulin resistance in myocardial ischemia: causes and consequences. Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2006; 10(3): 215 - 219. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Barsheshet, M. Garty, E. Grossman, A. Sandach, B. S. Lewis, S. Gottlieb, A. Shotan, S. Behar, A. Caspi, R. Schwartz, et al. Admission Blood Glucose Level and Mortality Among Hospitalized Nondiabetic Patients With Heart Failure. Arch Intern Med, August 14, 2006; 166(15): 1613 - 1619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The ACE/ADA Task Force on Inpatient Diabetes American College of Endocrinology and American Diabetes Association Consensus Statement on Inpatient Diabetes and Glycemic Control: A call to action Diabetes Care, August 1, 2006; 29(8): 1955 - 1962. [Full Text] [PDF]
|
|
|
|
|
|
Z Kadri, N Danchin, L Vaur, Y Cottin, P Gueret, M Zeller, J-M Lablanche, D Blanchard, G Hanania, N Genes, et al. Major impact of admission glycaemia on 30 day and one year mortality in non-diabetic patients admitted for myocardial infarction: results from the nationwide French USIC 2000 study Heart, July 1, 2006; 92(7): 910 - 915. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Arimura, M. Li, V. Batuman, W.F. Clark, A.K. Stewart, G.A. Rock, M. Sternbach, D.M. Sutton, B.J. Barrett, A.P. Heidenheim, et al. Cast Nephropathy in Myeloma--Does PACAP38, a New Member of the Vasoactive Intestinal Peptide Family, Open a Therapeutic Window?: Potential Protective Action of Pituitary Adenylate Cyclase-Activiating Polypeptide (PACAP38) on In Vitro and In Vivo Models of Myeloma Kidney Injury. Blood 107: 661-668, 2006 J. Am. Soc. Nephrol., April 1, 2006; 17(4): 911 - 919. [Full Text] [PDF]
|
|
|
|
 |
|
 J.R. Timmer, J.P. Ottervanger, H.J.G. Bilo, J.H.E. Dambrink, K. Miedema, J.C.A. Hoorntje, and F. Zijlstra Prognostic value of admission glucose and glycosylated haemoglobin levels in acute coronary syndromes QJM, April 1, 2006; 99(4): 237 - 243. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ishii, S. Ichimiya, M. Kanashiro, T. Amano, T. Matsubara, and T. Murohara Effects of Intravenous Nicorandil Before Reperfusion for Acute Myocardial Infarction in Patients With Stress Hyperglycemia Diabetes Care, February 1, 2006; 29(2): 202 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. D. Davis, K. Harwood, L. Midgett, M. Mabrey, and L. F. Lien Implementation of a New Intravenous Insulin Method on Intermediate-Care Units in Hospitalized Patients The Diabetes Educator, November 1, 2005; 31(6): 818 - 823. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. X. Freire, L. Bridges, G. E. Umpierrez, D. Kuhl, and A. E. Kitabchi Admission Hyperglycemia and Other Risk Factors as Predictors of Hospital Mortality in a Medical ICU Population Chest, November 1, 2005; 128(5): 3109 - 3116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Ramachandran, S. Chamukuttan, S. Immaneni, R. M. Shanmugam, N. Vishnu, V. Viswanathan, and T. Jaakko High Incidence of Glucose Intolerance in Asian-Indian Subjects With Acute Coronary Syndrome Diabetes Care, October 1, 2005; 28(10): 2492 - 2496. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Meier, S. Deifuss, A. Klamann, V. Launhardt, W. H. Schmiegel, and M. A. Nauck Plasma Glucose at Hospital Admission and Previous Metabolic Control Determine Myocardial Infarct Size and Survival in Patients With and Without Type 2 Diabetes: The Langendreer Myocardial Infarction and Blood Glucose in Diabetic Patients Assessment (LAMBDA) Diabetes Care, October 1, 2005; 28(10): 2551 - 2553. [Full Text] [PDF]
|
|
|
|
|
|
R.E. Anderson, K. Klerdal, T. Ivert, N. Hammar, G. Barr, and A. Owall Are even impaired fasting blood glucose levels preoperatively associated with increased mortality after CABG surgery? Eur. Heart J., August 1, 2005; 26(15): 1513 - 1518. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Veiraiah Hyperglycemia, Lipoprotein Glycation, and Vascular Disease Angiology, July 1, 2005; 56(4): 431 - 438. [Abstract] [PDF]
|
|
|
|
|
|
A. Abbate and G. G.L. Biondi-Zoccai The difficult task of glycaemic control in diabetics with acute coronary syndromes: finding the way to normoglycaemia avoiding both hyper- and hypoglycaemia Eur. Heart J., July 1, 2005; 26(13): 1245 - 1248. [Full Text] [PDF]
|
|
|
|
|
|
M. Zeller, P. G. Steg, J. Ravisy, Y. Laurent, L. Janin-Manificat, I. L'Huillier, J.-C. Beer, A. Oudot, G. Rioufol, H. Makki, et al. Prevalence and Impact of Metabolic Syndrome on Hospital Outcomes in Acute Myocardial Infarction Arch Intern Med, May 23, 2005; 165(10): 1192 - 1198. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. Rusavy, I. A. Macdonald, V. Sramek, S. Lacigova, P. Tesinsky, and I. Novak Glycemia Influences on Glucose Metabolism in Sepsis During Hyperinsulinemic Clamp JPEN J Parenter Enteral Nutr, May 1, 2005; 29(3): 171 - 175. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. B. Hirsch, R. M. Bergenstal, C. G. Parkin, E. Wright Jr., and J. B. Buse A Real-World Approach to Insulin Therapy in Primary Care Practice Clin. Diabetes, April 1, 2005; 23(2): 78 - 86. [Full Text] [PDF]
|
|
|
|
|
|
M. Bryer-Ash and A. J. Garber Point: Inpatient Glucose Management: The emperor finally has clothes Diabetes Care, April 1, 2005; 28(4): 973 - 975. [Full Text] [PDF]
|
|
|
|
|
|
S. E. Inzucchi and J. Rosenstock Counterpoint: Inpatient Glucose Management: A premature call to arms? Diabetes Care, April 1, 2005; 28(4): 976 - 979. [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Flaherty and C. J. Davidson Diabetes and Coronary Revascularization JAMA, March 23, 2005; 293(12): 1501 - 1508. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Ceriello Acute hyperglycaemia: a 'new' risk factor during myocardial infarction Eur. Heart J., February 2, 2005; 26(4): 328 - 331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Endorsed by the European Society of Intensive Care, Authors/Task Force Members, M. S. Nieminen, M. Bohm, M. R. Cowie, H. Drexler, G. S. Filippatos, G. Jondeau, Y. Hasin, J. Lopez-Sendon, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology Eur. Heart J., February 2, 2005; 26(4): 384 - 416. [Full Text] [PDF]
|
|
|
|
 |
|
 O. Akca and R. Lenhardt Letter to the Editors: Isn't It the Time to Consider Blood Glucose Concentration as Part of the Severity Assessment of Critically Ill Patients? J Intensive Care Med, January 1, 2005; 20(1): 52 - 53. [PDF]
|
|
|
|
 |
|
 A. Ceriello Postprandial Hyperglycemia and Diabetes Complications: Is It Time to Treat? Diabetes, January 1, 2005; 54(1): 1 - 7. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. M. Choi, K. W. Lee, S. G. Kim, N. H. Kim, C. G. Park, H. S. Seo, D. J. Oh, D. S. Choi, and S. H. Baik Inflammation, Insulin Resistance, and Glucose Intolerance in Acute Myocardial Infarction Patients without a Previous Diagnosis of Diabetes Mellitus J. Clin. Endocrinol. Metab., January 1, 2005; 90(1): 175 - 180. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Ceriello Insulin, Glycemic Control, and C-Reactive Protein During Myocardial Infarction Diabetes Care, December 1, 2004; 27(12): 3017 - 3018. [Full Text] [PDF]
|
|
|
|
|
|
S.-B. Catrina, K. Okamoto, T. Pereira, K. Brismar, and L. Poellinger Hyperglycemia Regulates Hypoxia-Inducible Factor-1{alpha} Protein Stability and Function Diabetes, December 1, 2004; 53(12): 3226 - 3232. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bartnik, L. Ryden, R. Ferrari, K. Malmberg, K. Pyorala, M. Simoons, E. Standl, J. Soler-Soler, J. Ohrvik, and on behalf of the Euro Heart Survey Investigators The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe: The Euro Heart Survey on diabetes and the heart Eur. Heart J., November 1, 2004; 25(21): 1880 - 1890. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kragelund, O. Snorgaard, L. Kober, B. Bengtsson, M. Ottesen, S. Hojberg, C. Olesen, J.-J. Kjaergaard, J. Carlsen, C. Torp-Petersen, et al. Hyperinsulinaemia is associated with increased long-term mortality following acute myocardial infarction in non-diabetic patients Eur. Heart J., November 1, 2004; 25(21): 1891 - 1897. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Carvalho and T. Schricker An ounce of prevention worth a pound of cure Can J Anesth, November 1, 2004; 51(9): 948 - 949. [Full Text] [PDF]
|
|
|
|
|
|
D. Aguilar, S. D. Solomon, L. Kober, J.-L. Rouleau, H. Skali, J. J.V. McMurray, G. S. Francis, M. Henis, C. M. O'Connor, R. Diaz, et al. Newly Diagnosed and Previously Known Diabetes Mellitus and 1-Year Outcomes of Acute Myocardial Infarction: The Valsartan in Acute Myocardial Infarction (VALIANT) Trial Circulation, September 21, 2004; 110(12): 1572 - 1578. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. B. Coursin and R. C. Prielipp The New Anesthesia Diet Plan: Keeping Perioperative Carbs in Check Anesth. Analg., August 1, 2004; 99(2): 316 - 318. [Full Text] [PDF]
|
|
|
|
|
|
A. Kouroedov, M. Eto, H. Joch, M. Volpe, T. F. Luscher, and F. Cosentino Selective Inhibition of Protein Kinase C{beta}2 Prevents Acute Effects of High Glucose on Vascular Cell Adhesion Molecule-1 Expression in Human Endothelial Cells Circulation, July 6, 2004; 110(1): 91 - 96. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Aljada, H. Ghanim, P. Mohanty, T. Syed, A. Bandyopadhyay, and P. Dandona Glucose intake induces an increase in activator protein 1 and early growth response 1 binding activities, in the expression of tissue factor and matrix metalloproteinase in mononuclear cells, and in plasma tissue factor and matrix metalloproteinase concentrations Am. J. Clinical Nutrition, July 1, 2004; 80(1): 51 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. LeRoith Editorial: A Blast from the Past--Insulin Does It Again! J. Clin. Endocrinol. Metab., July 1, 2004; 89(7): 3103 - 3104. [Full Text] [PDF]
|
|
|
|
 |
|
 K. S Lewis, S. L Kane-Gill, M. B. Bobek, and J. F Dasta Intensive Insulin Therapy for Critically Ill Patients Ann. Pharmacother., July 1, 2004; 38(7): 1243 - 1251. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R Timmer, J. P. Ottervanger, K. Thomas, J. C.A Hoorntje, M.-J. de Boer, H. Suryapranata, F. Zijlstra, and on behalf of the Zwolle myocardial infarction stud Long-term, cause-specific mortality after myocardial infarction in diabetes Eur. Heart J., June 1, 2004; 25(11): 926 - 931. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Barrett-Connor, E.-G. V. Giardina, A. K. Gitt, U. Gudat, H. O. Steinberg, and D. Tschoepe Women and Heart Disease: The Role of Diabetes and Hyperglycemia Arch Intern Med, May 10, 2004; 164(9): 934 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Stranders, M. Diamant, R. E. van Gelder, H. J. Spruijt, J. W. R. Twisk, R. J. Heine, and F. C. Visser Admission Blood Glucose Level as Risk Indicator of Death After Myocardial Infarction in Patients With and Without Diabetes Mellitus Arch Intern Med, May 10, 2004; 164(9): 982 - 988. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. B. Campbell and S. S. Braithwaite Hospital Management of Hyperglycemia Clin. Diabetes, April 1, 2004; 22(2): 81 - 88. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Spollett Glucose Control in a Hospitalized Person With Diabetes Diabetes Spectr, April 1, 2004; 17(2): 112 - 114. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Mudaliar Intense Management of Diabetes Mellitus: Role of Glucose Control and Antiplatelet Agents J. Clin. Pharmacol., April 1, 2004; 44(4): 414 - 422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H Laine, J Sundell, P Nuutila, O T Raitakari, M Luotolahti, T Ronnemaa, T Elomaa, P Koskinen, and J Knuuti Insulin induced increase in coronary flow reserve is abolished by dexamethasone in young men with uncomplicated type 1 diabetes Heart, March 1, 2004; |