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

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Horst, Iwan C.C. van der and Zijlstra, Felix and Hof, Arnoud W.J. van 't and Doggen, Carine J.M. and Boer, Menko-Jan de and Suryapranata, Harry and Hoorntje, Jan C.A. and Dambrink, Jan-Henk E. and Gans, Rijk O.B. and Bilo, Henk J.G. (2003) Glucose-insulin-potassium infusion inpatients treated with primary angioplasty for acute myocardial infarction: The glucose-insulin-potassium study: a randomized trial. Journal of the American College of Cardiology (5). pp. 784-791. ISSN 0735-1097

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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 ≥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 ≥2) at admission is uncertain
Item Type:Article
Copyright:© 2003, Elsevier
Link to this item:http://purl.utwente.nl/publications/77846
Official URL:http://dx.doi.org/10.1016/S0735-1097(03)00830-1
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