Glucose-insulin-potassium infusion inpatients treated with primary angioplasty for acute myocardial infarction: the glucose-insulin-potassium study: a randomized trial.

Abstract

OBJECTIVES:

In this study we considered the question of whether adjunction of glucose-insulin-potassium (GIK) infusion to primary coronary transluminal angioplasty (PTCA) is effective in patients with an acute myocardial infarction (MI).

BACKGROUND:

A combined treatment of early and sustained reperfusion of the infarct-related coronary artery and the metabolic modulation with GIK infusion has been proposed to protect the ischemic myocardium.

METHODS:

From April 1998 to September 2001, 940 patients with an acute MI and eligible for PTCA were randomly assigned, by open-label, to either a continuous GIK infusion for 8 to 12 h or no infusion.

RESULTS:

The 30-day mortality was 23 of 476 patients (4.8%) receiving GIK compared with 27 of 464 patients (5.8%) in the control group (relative risk [RR] 0.82, 95% confidence interval [CI] 0.46 to 1.46). In 856 patients (91.1%) without signs of heart failure (HF) (Killip class 1), 30-day mortality was 5 of 426 patients (1.2%) in the GIK group versus 18 of 430 patients (4.2%) in the control group (RR 0.28, 95% CI 0.1 to 0.75). In 84 patients (8.9%) with signs of HF (Killip class > or =2), 30-day mortality was 18 of 50 patients (36%) in the GIK group versus 9 of 34 patients (26.5%) in the control group (RR 1.44, 95% CI 0.65 to 3.22).

CONCLUSIONS:

Glucose-insulin-potassium infusion as adjunctive therapy to PTCA in acute MI did not result in a significant mortality reduction in all patients. In the subgroup of 856 patients without signs of HF, a significant reduction was seen. The effect of GIK infusion in patients with signs of HF (Killip class > or =2) at admission is uncertain.

• Authors: Iwan C C van der Horst, Felix Zijlstra, Arnoud W J van 't Hof, Carine J M Doggen, Menko-Jan de Boer, Harry Suryapranata, Jan C A Hoorntje, Jan-Henk E Dambrink, Rijk O B Gans, Henk J G Bilo, Zwolle Infarct Study Group
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 42 Issue 5 Pg. 784-91 (Sep 03 2003) ISSN: 0735-1097 [Print] United States
• PMID: 12957421 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Hypoglycemic Agents
• Insulin
• Glucose
• Potassium

Topics

• Age Factors
• Aged
• Angioplasty, Balloon, Coronary (methods)
• Cause of Death
• Combined Modality Therapy
• Diabetes Complications
• Female
• Fluid Therapy (methods)
• Glucose (therapeutic use)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Incidence
• Insulin (therapeutic use)
• Male
• Middle Aged
• Myocardial Infarction (complications, mortality, therapy)
• Potassium (therapeutic use)
• Proportional Hazards Models
• Risk Factors
• Severity of Illness Index
• Survival Analysis
• Time Factors
• Treatment Outcome