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1 2 ( ! # ! 34! ! #) 516 & 7 8 94! '!1

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1 0 0>? 1 : +

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+

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Fn Y F

4 f! $

8

\ 673

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R * "

Multinominal

Rergession Main Effect

<K .!P G 5-"3 4 O%3A

Zn 4 B OH P 8

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MI

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< @3

mg/dl UX DSX 8

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n Y X(

V

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= 3 -r3AR q-O 3A G-

3 8 L[

ES ' ) Y (Z V +

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$ - (S ' (F V +

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M @ 0 K

.%=>- 8

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I 8

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4 A

8

4 G <

"4 M ] 8

.f

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b& % "? 3A O 3 G- O LMI

L ! "L* "0"

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(Creatine phosphokinase) CPK H

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4

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mg/dl ZU DUU 3* <

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mg/dl DSF M = "?

mg/dl DSF [> 4 ' D +

4 A

8

! #

[ +

\ ]

"/ "

H A 1 2 ( ! # 3)

= 9

! ( " < ' 1 ! : < :! 0 Log rank

test=0.04 Survival Functions

DAYS

500 400 300 200 100 0 Cum Survi val

1.0 .9 .8 .7 .6 .5 .4 .3 .2 .1 0.0

BS140COD

>14 0 >140- censored

<=14 0 <=140- censored

3 < 673

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mg/dl DSF

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M \^ " < s * $ H :

4 3 8 - H 3A . M m" . \.$%&

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M p7

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<

O 3

4 \^

FE Y F Pt ' E Y ) u D Y CI D Zn + Odds E

ratio = 8

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3 $

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& "- ; <

4 3 " < [ .

K M :_ -OG.

mg/dl DFF

DD V

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%1

M $ e .

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P ^

+ ] B * ( ! # H 1 ) "& ? _ [

3) H 1

\

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FFD Y

<F FX Y F

( Y F

FFD Y

<F Fn Y F

FZ Y F

FE Y F

D(

) Y UF

(E ' X Y XU V +

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n ' D Y DX V +

DX ' nF V +

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V +

ZU DUU

D(

Z Y nZ

XX ' n Y )(

V +

EE ' E Y SD V +

U ' ( Y Z V +

(n ' E Y ED V +

E) ' n Y SU V +

X) DE)

DE D Y XE

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D(

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SD ' X Y EX V +

SZ ' SE V +

UX DSn

/ ' +

@ MI ! .f

] ?G

Q%/ - (mg/dl) @3

P ^

D ]

"": M _ a b Z ; * c ! : ; < :! 0 = 9 ( ! # 3) '! # a 1 d 1 ) A

E P ' V ( '! # a d 1 &1 `

P.value Odds ratio P.value Odds ratio

FFS Y F

( Y F

D Y F

' Z Y U u S Y D + S Y E

' U Y S u U Y F + ) Y D

' n Y n u ) Y F + D Y (

FX Y F

E Y F

FE Y F

' ) Y n u Z Y F + E Y (

' D Y S u n Y F + n Y D

' E Y ) u D Y D + E

H

! MI .

(mg/dl)

e / N-4 M ."G- <= !H Q:

1 2 " 3 <

4 8

R %

DZ)E .$%&

Whitehall _ f3

<= !H Q:

.

I ! M - < - H _ 0 I

4 4 A* 4 3

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8+

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8

M @3* v

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mmol/dl DD

u U Y X " T !"# $%&

8

4 wM @3* -

!!<% k G . b&

3 4 673 x I .

8 p %

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mg/dl DSF . I

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8

/ 3 4 =3 5-"3k K odds ratio'

+ [

G 3 " <

M = - "?

mg/dl DSF

[ f H . =3

' E Y ) u D Y D CIL Zn + E 8

<= !H Q: -A. - 7 - y & .!z=

RJ" l3 M @- [ I - 4 2 " * 4 3 { _ f3 A O 3 O !H q= % "

* 4 3 <= !H Q:

2 "

.

H _ -OG P

, - K p

%1

7-M . * q= 3 > .e H 4 T -$ 1 , -| %-OG - f% q= 3 > - e L = 3 4 ." 4 vJ A

6 @ : : "= _ -OG[ 4 . 4 ? 0. *

!H _ -O GL " ] [> 4 . 2 "

O3| z3 _ :

O3| > !H .

M : :_ -OG K

: _ -OG

4 %=3 . & g f

' X

8+

, = \ 4 7-. "!I : <= !H Q:

%! >!<I

% k -K * v] <"1 1 <= !H Q:

H = 2 " x I *AM %>- 8

<= !H Q:

= k -K* >< a<:

. M

!H LO !H

* J- L

%! [ 4 R $G -2 =1

M : polyol

4 = 2 " . 7

8 a<:

H 6 ! 3 >!<IRJ" x I <= !H Q:

8 -.

} I = 3 . P

6 ! 3 . ."=

. 2 < .!

j "#

'

I e 1

+ M : l!;

e M ]

4 RJ"

' ) L U

8+

.7 "3 a<:R ! 3 >!<IRJ"

- 3 ] j g h 1 *AM :R >- _ -O G

. J-* > !H

, -"3 = +NO)

R $G ;

' DF L Z

8+

x I *AM :R >- H = e * _ -OG

%>%

Adhesion molecule) H +

8 _ -OG

* z 0 %$G_ -OGx I a<:

H C

' D(

8+

4 <= !H Q: 1 \ 4 w

e :

* / 0 "1 <= !H Q: \. M : 4

3 $ K %1 . ?H*

3 O

8

: ~ 1 <= !H Q: <: !"# %! m

* z 0 %$G_ -OGk -K * v] <"1 . _ -OGLC

• |J b 4 _ -OGL ! 3 b4

">3 G IV

% >% H = e * _ -O G

} I6 ! 3 .

' 4

DS L DE

8+

4 ? 3 %! , = \ JI

. I J- * # \ <= !H Q:.

x I .7 "3

H <>=- 4

' Dn

8+

m

q= % "

.

_ -OG O !H 9 j _ : !I

*Ac e M : =

L

< _ f3 HA_ 0

- < c !& 3

' DX

8+

MI 1 M : b& _ -O G <: <= !H Q:

* _ -OG "%

T cell

* _ : , = " M :

T helper cell :

. 0 4 g x I [ I -

H <- 3

8 l3 . q= 3 > , - 3 .

_ 0 % <"1 HA

* / 0T $ o

< MI

4 1 <= !H Q:

' DU

8+

.$%&

o 1 3 " < 673 <= !H Q:

l3 * .%= >-673 <= !H Q: L <:

3 $ M A

8

.$%&

(DIGAMI) Diabetes and Insulin Glucose

Infusion in AcuteMI

"% , -

3] K .

A 8

g . : H -

4 - O3 3 %=3 - 4

' D)

8+

.$%&

Norhammar l3 O 3

DIGAMI

. 3 ? 3

. J" "- ; < M < J0 b &

1MI 3] K 673 [f"= - H _ 0[ I, -

' D

8+

Hadjadj _ 3 ><:

' DZ

. 3 ?3+

k & * / 0 "1 .!-* > !H !H <: O

HbA1C

* $ "% - H _ 0[ I

4 MI 8 5- "3

$o . ?3 a<: 3A.$%&

1 q= % "

_

0 O $o *

A_

H

* $ _ f3MI

8

_ 3 ><: Sala

' DD

. 3 ? 3 M .$%& +

mmol/l* _ XU Y X , -

?3

@3

"% [f"=

()

* / 0 *

* A_ f3 "1 . * - . 4 MI

4 ` #? -

"?

8

Stranders _ 3 ><:

' (F

. 3 ?3+

3] K "% [f"= - H _ 0[ I MI

4 " - ; < q : "- < q:

.

M K _ -O G . D)mg

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3] K "%

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S V

<

"- n V - _ -OG 8

%1 _ -OG o 1 .$%& .

mg/dl : DFF DD

V , = - _ -OG

K e <: 3 " < [

? 3 - .% , - 8

.$%&

o 1

9 j * l3 - : " G

\^ L* K m L -p ; I - A

c & o L 4 C 4 l3 < 1 M : $

.$%& M : - g * . 4 ."GH - 3 / 3 @ 4 8 M OH !H [<g = e GK * 673 <

- 6 I` #? ?3

R 1 y 4 2

= 3 <"1 < "- ;.7 "3 8

H 1 5 H b& . W !& - 5- "3 O !

v] <"1 M < J0

?3

@3

< ` #? M

HA_ 0 MI * $

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H O <"MI 8

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8

References

1- Norhammar A, Ryden L, Malmberg K.

Admission plasma glucose independent risk factor for long-term prognosis after myocardial infarction even in nondiabetic patients; Diabetes Care, 1999 , Vol 22, No 11; Nov, 1827-31.

2- Pyoralak, Samvolainen E, Lehtovirta E. Glucose tolerance and coronary Heart disease: helsinki Policemen study. J Chronic Dis 1979, 32:

729-745.

3- Fuller JH, Shipley MJ, Rose G, Jarrett RJ, Keen H. Coronary heart disease risk and impaired glucose tolerance : The whiehall study, Lancet1980, I:

1373-76.

4- Fuller JH, Shipley MJ, Rose G. Mortality from coronary heart disease and stroke in relation to degree of glycemia : The whiehall study, BMJ 1983; 287; 867-70.

5- Capes SE, Hunt D, Malmberg K . Stress Hyperlipidemia and increased risk of death after myocardial infarction in patients with and without diabets; a systematic overview. Lancet 2000; 355 : 773-89.

6- Umpierrel GE, Isaacs ID, Bazargan N.

Hyperglycemia: An independent marker of in- hospital mortality in patients with undiagnosed diabetes. J Clin En & Met , 2002; 87(3) : 978-982.

7- Cohen RA. Dysfunction of vascular endothelium in diabetes melitus. Circulation 1993; 87(suppl 5):

67-76.

8- Tesfamariam B, Cohen RA. Free radials mediate endotheial cell dysfunction caused by elevated glucose: Am J physiol, 1992; 263(2 pt 2) :H 321-6.

9- Keegan A, Walbank H, Cotter MA. Chronic Vit

E treatment prevents defective endothelium- dependent relaxation in diabetic rat aorta.

Diabetotogia, 1995; 38; 1475-8.

10- Bucala R, Tracey KJ, Cerami A. Advanced glycosile products quench nitric oxide and mediate defective endothelium – dependent vasodilation in experimental diabetes, J Clin Invest. 1991;87:

432-8.

11- Sale J, Masia R, Gonzalez FJ, Fernandeez- Real JM, Gil M, Bosch D, Ricart W, et al. Short- term mortality of myocardial infarction patients with diabetes or hyperglycemia during admission. J Epi comn Health, 2002, 56; 707-712.

12- Ceriello A. Acute hyperglycemia and oxidative stress generation Diabet Med 1997; 14(suppl) : S45-9.

13- Williams B. Glucose- induced vascular smooth muscle dysfunction : The role of protein kinase C, J Hypertens 1995; 13: 477-86.

14- Baumgartner- prazar SM, Wagner L, Pettermann M. Modulation by high glucose of adhession molecule expression in cultured endothelial cell. Diabetologia 1995; 38; 1367-70.

15- Gilcrease MZ, Hoover RL. Examination of monocyte adherence to endothelium under

hyperglycemia conditions. Am J pathol 1991,139:

1089-97.

16- Rodrigues B, MC Neill JH. The diabetic heart:

Metabolic causes for the development of cardiomyopathy. Cardiovascular Res ,992; 26:

913-922.

17- Marfella R, Sinincalchi M, Esposito K. Effects odd stress hyperglycemia on acute myocardial infarction role of inflamatory immune process in functional cardiac outcome. Diabetes Care, 2003 Nov ; Vol 26.

18- Malmberg K, Norhammar A, Wedel H`.

Glycometabolic state at admission: Important Risk marker of mortality in conventioally treated patients with diabetes mellitus and Acute myocardial infarction. Circulation 1999, 99:2626-2632.

19- Hdjadj S, Coisne D, Mauco G , Ragot S, Duengler F, Sosner P, Torremocha F & et al.

Prognostic value of admission plasma glucose and HbA in acute myocardial infarction. Diabet Med, 2004 Apr; 21(4): 305-10.

20- Stranders I, Diamant M, Van Gelder RE, Spruijt HJ, Twisk JW, Heine RJ, Visser FC.

Admission blood glucose level at risk indicator of death afetr myocardial infarction in patients with and without diabetes mellitus. Arch Intern Med, 2004, May 10; 164(9): 982-8

.