Oxidative stress after reperfusion with primary coronary angioplasty: lack of effect of glucose-insulin-potassium infusion.
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.
Díaz-Araya
Guillermo
G
Department of Pharmacological and Toxicological Chemistry (GD-A), University of Chile, Santiago. gadiaz@ciq.uchile.cl
Nettle
Danniels
D
Castro
Pablo
P
Miranda
Fernando
F
Greig
Douglas
D
Campos
Ximena
X
Chiong
Mario
M
Nazzal
Carolina
C
Corbalán
Ramón
R
Lavandero
Sergio
S
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
D015415:Biomarkers; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D008315:Malondialdehyde; D002374:Catalase; D005979:Glutathione Peroxidase; D013482:Superoxide Dismutase; D005947:Glucose; D011188:Potassium