Abstract 11483: Intense Glycemic Control After Myocardial Infarction Improves Long-Term Survival. Twenty Year Follow Up of the Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction Study
Background: Information on long-term impact of intense glucose lowering treatment after acute myocardial infarction (AMI) is contradictory. We report on total mortality during 20 years of follow up of the first Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study.
Methods: Patients with diabetes mellitus admitted to 19 Swedish hospitals for an AMI were 1990-93 randomized to standard AMI treatment plus insulin-glucose infusion during at least 24 hours followed by multidose insulin (n= 306) or to standard treatment (n= 314). At randomization patients were stratified in four groups1: low-risk + no previous insulin (n=272); 2: low risk + previous insulin (n=129); 3: high-risk + no previous insulin (n=119); 4: high risk + previous insulin (n=100). High-risk patients fulfilled ≥two of the following criteria: age >70, digitalis, previous heart failure, previous MI. Cox proportional hazard regression analyses was used to compare the impact of randomized treatment on mortality. Outcome: Patients were followed for mortality until Dec 31 2011 via the Swedish DeathRegistry.
Results: During an average follow up of 7.3 (range: 0-22) years the number of deaths were 271 (89%) in the insulin and 285 (91%) in the control group. The average survival time was 7.0 years (IQR 5.6:7.8) in the insulin and 4.7 (3.8:5.7) in the control group (HR 95%CI 0.83; 0.70-0.98, p=0.027). Patients in group 1 had the most pronounced survival benefit (0.77; 0.60-1.00, p=0.047). As can be seen in the figure Kaplan-Meier curves revealed that the effect of intense glucose treatment lasted 8 years after the index MI.
Conclusion: Insulin-glucose infusion followed by intensive subcutaneous insulin in patients with diabetes admitted for AMI in 1990-1993 improved long-term survival for at least 8 years and was thereafter attenuated. Figure: Time to mortality after myocardial infarction in insulin (blue) and control (red) patients (log-rank 0.027).
- © 2013 by American Heart Association, Inc.