Copyright © 1996 by the European Society of Cardiology.
© 1996 The European Society of Cardiology
Effects of insulin treatment on cause-specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction
*Department of Cardiology, Karolinska Sjukhuset Stockholm
Department of Medicine, Karolinska Sjukhuset Stockholm
Department of Medicine, Sahlgrenska Sjukhuset Göteborg
Department of Medicine, Norrlands Universitetssjukhus Umea
¶Nordiska Hälsovardshögskolan Göteborg Sweden
revised 13 January 1996; accepted 15 February 1996.
Correspondence: Klas Malmberg, MD, Department of Cardiology, Karolinska Hospital, Box 110, 5-171 76 Stockholm, Sweden.
Abstract
Diabetic patients with acute myocardial infarction have a poor prognosis, which has been attributed to a higher incidence of congestive heart failure and fatal reinfarction. This study reports on the one-year morbidity and mortality in a randomized study with the aim of testing whether insulin–glucose infusion initiated as soon as possible after onset of myocardial infarction and followed by long-term subcutaneous insulin treatment may have a beneficial effect on outcome in diabetic patients. In all, 306 patients were recruited to the insulin-treated group, while 314 patients served as controls.
The overall mortality after one year was l9% in the insulin group compared to 26% among controls (P<0.05). The treatment effect was most pronounced in patients with out prior insulin medication and at low cardiovascular risk. In this stratum the in-hospital mortality was reduced by 58% (P<0.05) and the one-year mortality by 52% (P<0.02).
The most frequent cause of death in all patients was congestive heart failure (66%), but cardiovascular mortality (congestive heart failure, fatal reinfarction, sudden death and stroke) tended to be decreased in insulin-treated patients. However, this difference did not reach the level of statistical significance. The number of reinfarctions was 53 (28% fatal) in the insulm group compared to 55 (45% fatal) in the control group. The two groups did not differ as regards need for hospital care or coronary revascularization during the year of follow-up.
In summary, left ventricular failure and fatal reinfarctions contribute to increased mortality in diabetic patients following acute myocardial infarction. Intensive insulin treatment lowered this mortality during one year of follow-up.
Key Words: Diabetes mellitus • acute myocardial infarction • insulin treatment • morbidity • mortality • prognosis
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
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|
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|
|