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Mortality prediction in diabetic patients with myocardial infarction: experiences from the DIGAMI study
K Malmberg1, L Rydén, A Hamsten
1Department of Cardiology, Karolinska Hospital, Stockholm, Sweden.
Insights
Diabetic patients with acute myocardial infarction (AMI) benefit from intensive insulin therapy, which significantly reduces 1-year mortality. Good metabolic control, not conventional risk factors, is key for survival post-AMI in this population.
Area of Science:
- Cardiology
- Diabetology
- Clinical Research
Background:
- Diabetic patients with acute myocardial infarction (AMI) face a poor prognosis.
- The DIGAMI study investigated if poor metabolic control contributed to this outcome.
- Intensive insulin treatment in DIGAMI reduced 1-year mortality by 30%.
Purpose of the Study:
- To analyze predictors of 1-year mortality in diabetic patients after AMI.
- To evaluate the impact of metabolic control and conventional risk factors on mortality.
- To assess the secondary-preventive effect of beta-blockade in this cohort.
Main Methods:
- Analysis of the DIGAMI cohort comprising 620 diabetic patients with AMI.
- Application of uni- and multivariate statistical methods.
- Comparison between a control group (314 patients) and an intensive insulin treatment group (306 patients).
Main Results:
- Age, prior myocardial damage, diabetes duration, and insulin therapy predicted mortality.
- Conventional risk factors lacked independent prognostic significance.
- High blood glucose at admission was a strong predictor of mortality; beta-blockade showed a significant secondary-preventive effect.
Conclusions:
- Good metabolic control is crucial for diabetic patients post-AMI, more so than conventional risk factors.
- Beta-blockade therapy demonstrates significant importance for secondary prevention in this patient group.
Objectives:
We analysed predictors of 1-year mortality following acute myocardial infarction in patients with diabetes mellitus by applying uni- and multivariate statistics on the DIGAMI cohort.
Background:
Diabetic patients with acute myocardial infarction have a poor prognosis. This may depend on a poor metabolic control, a hypothesis that was tested in DIGAMI, a prospective randomised study. In this trial institution of immediate intensive insulin treatment reduced 1-year mortality by 30%.
Methods:
We recruited 620 diabetic patients with acute myocardial infarction, 314 of whom served as controls, while the remaining 306 patients were treated with an acute insulin-glucose infusion followed by multidose subcutaneous insulin.
Results:
Age, previous myocardial damage, duration of the diabetes and previous insulin therapy were significantly related to 1-year mortality, while conventional risk factors lacked independent prognostic weight. Female sex was not linked to mortality when controlling for the confounding effects of other predictors. One of the strongest predictors of a fatal outcome, in particular during the hospital phase, was blood glucose at hospital admission. Beta-blockade appeared to exert a striking, independent secondary-preventive effect.
Conclusions:
It seems that good metabolic control and not conventional risk factors is of major importance for diabetic patients sustaining acute myocardial infarction. Also treatment with beta-blockade seems to be of special importance in this category of patients.