MORTALITY PREDICTION IN DIABETIC-PATIENTS WITH MYOCARDIAL-INFARCTION - EXPERIENCES FROM THE DIGAMI STUDY

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: Dia betic patients with acute myocardial infarction have a poor prognosis, This may depend on a poor metabolic control, a hypothesis that was te sted in DIGAMI, a prospective randomised study. In this trial institut ion of immediate intensive insulin treatment reduced 1-year mortality by 30%. Methods: We recruited 620 diabetic patients with acute myocard ial infarction, 314 of whom served as controls, while the remaining 30 6 patients were treated with an acute insulin-glucose infusion followe d-by multidose subcutaneous insulin. Results: Age, previous myocardial damage, duration of the diabetes and previous insulin therapy were si gnificantly related to 1-year mortality, white conventional risk facto rs lacked independent prognostic weight, Female sex was not linked to mortality when controlling for the confounding effects of other predic tors. One of the strongest predictors of a fatal outcome, in particula r during the hospital phase, was blood glucose at hospital admission. Beta-blockade appeared to exert a striking, independent secondary-prev entive effect. Conclusions: It seems that good metabolic control and n ot conventional risk factors is of major importance for diabetic patie nts sustaining acute myocardial infarction. Also treatment with beta-b lockade seems to be of special importance in this category of patients .