Coronary revascularization: a procedure in transition from on-pump to off-pump? The role of glucose-insulin-potassium revisited in a randomized, placebo-controlled study.
OBJECTIVE
To investigate an optimized glucose-insulin-potassium (GIK) solution regimen as an alternate myocardial protective strategy in off-pump coronary artery bypass graft (OP-CAB) surgery and as a supplement to conventional coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass (CPB).


METHODS
Prospective, randomized, placebo-controlled.


METHODS
Single institution, cardiothoracic specialty hospital.


METHODS
Forty-four patients scheduled for elective multivessel coronary artery surgery using either conventional CPB (n = 22) or OP-CAB techniques (n = 22).


METHODS
Preischemic, ischemic, and postischemic administration of GIK solution was carried out, optimally dosed to ensure nonesterified fatty acid (NEFA) suppression, and supplemented with magnesium, a glycolytic enzymatic cofactor.


RESULTS
GIK solution therapy reduced plasma NEFA levels (p < 0.001) in OP-CAB surgery and CPB groups but failed to affect the incidence of non-Q wave perioperative myocardial infarction, incidence of postoperative atrial fibrillation, incidence of postoperative infection, reduction in creatinine clearance, or duration of postoperative intensive care unit or hospital length of stay. After adjusting for GIK solution therapy, OP-CAB surgery resulted in significantly less ischemic injury (troponin I >15 microg/L, 19.0% v 91.3%; p = 0.0001) and reduced postoperative infections (14.3% v 43.5%; p = 0.049).


CONCLUSIONS
GIK solution therapy achieved NEFA suppression and an insignificant trend toward reduced biochemical parameters of ischemic injury in OP-CAB surgery and CPB groups, but no major clinical benefit (perioperative myocardial infarction, intensive care unit length of stay, or hospital length of stay) was shown after elective CABG surgery in low-risk patients. Compared with CPB, OP-CAB surgery significantly reduced ischemic injury and postoperative infections.
Smith
Andrew
A
Department of Anesthesiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
Grattan
Amanda
A
Harper
Mark
M
Royston
David
D
Riedel
Bernhard J C J
BJ
D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000097:blood / Q000188:drug therapy / Q000601:surgery; D003402:Creatine Kinase / Q000097:blood / Q000187:drug effects; D052279:Creatine Kinase, MB Form; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005947:Glucose / Q000502:physiology; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000502:physiology; D007527:Isoenzymes / Q000097:blood / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy / Q000601:surgery; D009204:Myocardial Revascularization / Q000379:methods*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D011188:Potassium / Q000502:physiology; D011446:Prospective Studies; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood / Q000187:drug effects; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000188:drug therapy / Q000601:surgery
D015415:Biomarkers; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D007527:Isoenzymes; D019210:Troponin I; C030396:glucose-insulin-potassium cardioplegic solution; D003404:Creatinine; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D005947:Glucose; D011188:Potassium