Effects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty.
OBJECTIVE
To evaluate the effects of glucose-insulin-potassium (GIK) therapy on infarct size and left ventricular function when used as an adjuvant therapy to primary angioplasty.


METHODS
Prospective, randomized, double-blind, placebo-controlled study.


METHODS
Cardiac intensive care unit at a university hospital.


METHODS
Thirty-seven patients with acute myocardial infarction for whom primary angioplasty was indicated.


METHODS
Eligible patients were randomized by a blinded pharmacist to GIK solution (30% glucose in water with insulin 50 U/L, and KCl 40 mM/L) vs. placebo at 1.5 mL/kg/hr for 24 hrs.


RESULTS
Tc 99m sestamibi myocardial scintigraphy was performed at admission and at 3 months. Primary end points were the changes in left ventricular ejection fraction (LVEF) and the size of salvaged myocardium. Baseline clinical characteristics were similar in both groups. At the 3-month follow-up, a significant overall decrease in infarct size (37 +/- 16% vs. 12 +/- 10%, p <.005) and an increase in LVEF (34 +/- 13% vs. 49 +/- 9%, p =.005) were observed. Patients randomized to GIK solution experienced a significant increase in their LVEF at 3 months (39 +/- 12 to 51 +/- 13, p =.002). Patients who received placebo had no significant differences between baseline and 3-month measurements (44 +/- 13 vs. 49 +/- 14, p = NS). There was a trend toward an increase in myocardial salvage in the GIK group, which did not reach statistical significance. When patients from both groups were compared directly, differences in LVEF improvement were no longer significant.


CONCLUSIONS
GIK solution did not improve LVEF or decrease the infarct size among patients undergoing primary angioplasty.
Castro
Pablo F
PF
Department of Cardiovascular Diseases, Hospital Clínico de la Pontificia Universidad Católica de Chile, Santiago, Chile.
Larrain
Germán
G
Baeza
Ricardo
R
Corbalán
Ramón
R
Nazzal
Carolina
C
Greig
Douglas P
DP
Miranda
Fernando P
FP
Pérez
Osvaldo
O
Acevedo
Mónica
M
Marchant
Eugenio
E
Olea
Enrique
E
Gonzalez
Rolando
R
D015906:Angioplasty, Balloon, Coronary; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D002677:Chile; D004311:Double-Blind Method; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D009206:Myocardium; D011188:Potassium / Q000008:administration & dosage*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D017256:Technetium Tc 99m Sestamibi; D005947:Glucose; D011188:Potassium