Plasma Glucose at Hospital Admission and Previous Metabolic Control Determine Myocardial Infarct Size and Survival in Patients With and Without Type 2 Diabetes
The Langendreer Myocardial Infarction and Blood Glucose in Diabetic Patients Assessment (LAMBDA)
- Juris J. Meier, MD12,
- Silvia Deifuss, MD1,
- Andreas Klamann, MD1,
- Volker Launhardt, MD1,
- Wolff H. Schmiegel, MD, PHD1 and
- Michael A. Nauck, MD, PHD13
- 1Department of Medicine, Ruhr-University, Knappschafts-Krankenhaus, Bochum, Germany
- 2Larry Hillblom Islet Research Center, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
- 3Diabeteszentrum Bad Lauterberg im Harz, Bad Lauterberg, Germany
- Address correspondence and reprint requests to Prof. Dr. med. Michael A. Nauck, Diabeteszentrum Bad Lauterberg, Kirchberg 21, D-37431 Bad Lauterberg, Germany. E-mail: m.nauck{at}diabeteszentrum.de
Hyperglycemia at the time of hospital admission has been associated with shorter survival after acute myocardial infarction in patients both with and without diabetes (1–5). It is not fully understood whether this is due to the acute development of stress hyperglycemia or to the quality of long-term metabolic control before the event (6). Moreover, the mechanisms by which hyperglycemia in the postinfarction period affects survival are largely unknown. In the present study, the LAMBDA (Langendreer Myocardial Infarction and Blood Glucose in Diabetic Patients Assessment) database was used to investigate the influence of acute (plasma glucose determined on admission) and long-term (HbA1c [A1C]) glycemic control on the size of myocardial necroses and prospective long-term survival after >3.5 years.
RESEARCH DESIGN AND METHODS
Clinical data of all patients admitted to the Department of Medicine of Ruhr-University, Knappschafts-Krankenhaus, Bochum (Langendreer), between 1 January 1991 and 30 June 1997 who were diagnosed with acute myocardial infarction were collected as described (4,7). All patients, their nearest spouses, and the responsible general practitioners were contacted after >3.5 years to obtain information on the vital status. In the present analysis, data from 227 type 2 diabetic and 287 nondiabetic patients were examined. Both groups were divided in tertiles according to the plasma glucose concentrations determined at hospital admission. All creatine kinase (CK) activities (including CKMB [muscle/brain]) were determined twice daily at 12-h intervals in each patient. All patients received standard clinical care including monitoring …
