title: Oxidative stress after reperfusion with primary coronary angioplasty: lack of effect of glucose-insulin-potassium infusion.
abstract: OBJECTIVE
  To evaluate the oxidative stress status and the modification with glucose-insulin-potassium (GIK) therapy in patients with acute myocardial infarction undergoing primary percutaneous transluminal coronary angioplasty.
  
  
  METHODS
  Prospective, randomized, double-blinded, placebo-controlled study.
  
  
  METHODS
  Cardiac intensive care unit at the university hospital.
  
  
  METHODS
  Twenty patients were randomized to GIK solution (30% glucose in water with insulin 50 IU/L, and KCl 40 mM) vs. placebo (normal saline) at 1.5 mL/kg/hr for 24 hrs. The control group was 15 healthy volunteers with no heart disease.
  
  
  METHODS
  Eligible patients were randomized by a blinded pharmacist, patients with acute myocardial infarction were treated by primary percutaneous transluminal coronary angioplasty and randomized to GIK or placebo (saline solution). Primary angioplasty was successful in nine of ten patients (90%) and ten of ten patients (100%) in the GIK and placebo groups, respectively. Nine (100%) and six (60%) patients from GIK and placebo groups, respectively, underwent stent implantation.
  
  
  RESULTS
  We determined plasma levels of lipid peroxidation estimated by the malondialdehyde assay, superoxide dismutase, glutathione peroxidase, and catalase erythrocyte activities at admission and 0.5 and 24 hrs after angioplasty. Baseline determinations were compared with a control group (n = 15). Baseline clinical characteristics and time to treatment (4.5 +/- 3.5 hrs) were similar between groups. Angioplasty success rate (Thrombolysis in Myocardial Infarction [TIMI] 3 flow with residual stenosis < or = 30%) was 90% and 100% in GIK and placebo groups, respectively. Patients with acute myocardial infarction had an increase of malondialdehyde at baseline (2.9 +/- 1.7 vs. 1.1 +/- 0.3 microM, p <.01) and lower enzymatic activities of superoxide dismutase (0.5 +/- 0.5 vs. 1.3 +/- 0.4 U/mg hemoglobin, p <.01) and catalase (147 +/- 73 vs. 198 +/- 31 U/g hemoglobin, p <.01). These measurements did not change significantly after angioplasty and no differences were observed between GIK and placebo groups.
  
  
  CONCLUSIONS
  Patients with acute myocardial infarction had increased levels of oxidative stress associated with a reduction in enzymatic antioxidant reserve. Administration of GIK solution did not improve these abnormalities among patients undergoing primary angioplasty.
authors.affiliation: Department of Pharmacological and Toxicological Chemistry (GD-A), University of Chile, Santiago. gadiaz@ciq.uchile.cl
authors.forename: Guillermo
authors.initials: G
authors.lastname: Díaz-Araya
authors.forename: Danniels
authors.initials: D
authors.lastname: Nettle
authors.forename: Pablo
authors.initials: P
authors.lastname: Castro
authors.forename: Fernando
authors.initials: F
authors.lastname: Miranda
authors.forename: Douglas
authors.initials: D
authors.lastname: Greig
authors.forename: Ximena
authors.initials: X
authors.lastname: Campos
authors.forename: Mario
authors.initials: M
authors.lastname: Chiong
authors.forename: Carolina
authors.initials: C
authors.lastname: Nazzal
authors.forename: Ramón
authors.initials: R
authors.lastname: Corbalán
authors.forename: Sergio
authors.initials: S
authors.lastname: Lavandero
mesh_terms: D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers; D002374:Catalase / Q000187:drug effects / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D005947:Glucose / Q000494:pharmacology*; D005979:Glutathione Peroxidase / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000494:pharmacology*; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D018384:Oxidative Stress / Q000187:drug effects*; D011188:Potassium / Q000494:pharmacology*; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000517:prevention & control; D013482:Superoxide Dismutase / Q000187:drug effects / Q000378:metabolism
chemical_list: D015415:Biomarkers; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D008315:Malondialdehyde; D002374:Catalase; D005979:Glutathione Peroxidase; D013482:Superoxide Dismutase; D005947:Glucose; D011188:Potassium