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
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
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DOI：
10.1161/01.cir.99.20.2626
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发表时间：
1999-05-25
期刊：
影响因子：
37.8
通讯作者：
Rydén, L
中科院分区：
文献类型：
--
作者：
Malmberg, K;Norhammar, A;Rydén, L
背景：糖尿病和胰岛素-葡萄糖输注急性心肌梗死（DIGAMI）研究探讨了糖尿病合并心肌梗死（AMI）患者的预后因素以及伴随治疗和糖代谢控制的影响。方法与结果：620例糖尿病AMI患者中，306例随机分为24小时以上胰岛素-葡萄糖输注组，随后多剂量皮下胰岛素输注组。314名患者被随机分为对照组，接受常规的抗糖尿病治疗。可能时给予溶栓和p受体阻滞剂。单因素和多因素统计分析应用于研究长期死亡率的预测因素。在平均3.4年（1.6 ~ 5.6年）的随访期间，强化胰岛素组102例（33%）死亡，对照组138例（44%）死亡（P=0.011）。在整个队列中，年龄、既往心力衰竭、糖尿病病程、入院血糖和入院Hb A（1c）是死亡率的独立预测因素，而既往AMI、高血压、吸烟或女性没有增加独立预测价值。代谢控制，反映血糖和血红蛋白（1c），在强化胰岛素治疗的患者中，明显改善比对照组更多。受体阻滞剂改善了对照组患者的生存，而溶栓在强化胰岛素治疗组最为有效。结论：糖尿病AMI患者的死亡率与年龄、既往心力衰竭和入院时糖代谢状态的严重程度有关，而与常规危险因素或性别无关。尽管入院时血糖和血红蛋白（1c）较高，但强化胰岛素治疗降低了长期死亡率。
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 greater than or equal to 24-hour insulin-glucose infusion followed by multidose subcutaneous insulin. Three hundred fourteen patients were randomized as controls, receiving routine antidiabetic therapy. Thrombolysis and P-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 A(1c) 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 A(1c), improved significantly more in patients on intensive insulin treatment than in the control group. beta-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 A(1c).