Long-term follow-up of the randomized (BIOMArCS-2) glucose trial

In the BIOMArCS-2 Glucose (Randomized Trial to Evaluate the Clinical Value of Intensive Glucose Monitoring and Regulation in Myocardial Infarction) trial, intensive glucose control (IGC) did not reduce myocardial infarction (MI) size in ST-segment–elevation MI or non–ST-segment–elevation MI patients presenting with hyperglycemia. In fact, IGC was associated with excess in-hospital death or MI (8 versus 1 event).1 Because these findings were unexpected, we executed a longer-term extension of the original trial cohort. In BIOMArCS-2 Glucose, 280 MI patients with admission blood glucose 140 to 288 mg/dL were randomly assigned to either IGC with intravenous insulin for 48 hours aiming for plasma levels of 85 to 110 mg/dL versus conventional management (control).1 The protocol was approved by the local Medical Ethics committee, and all patients provided written informed consent. In January 2016, median follow-up was 5.1 years (interquartile range, 4.0–6.2). We obtained data on vital status from municipal registries and on MI by reviewing medical records. MI was defined as typical chest pain accompanied by a rise of troponins. Follow-up on all-cause death and MI was 99.3% and 97.5% of patients, respectively. Patients with incomplete follow-up data were censored after their last hospital …