title: A randomized evaluation of the effects of glucose-insulin-potassium infusion on myocardial salvage in patients with acute myocardial infarction treated with reperfusion therapy.
abstract: BACKGROUND
  Intravenous glucose-insulin-potassium (GIK) may have a positive metabolic influence in patients with acute myocardial infarction (AMI) who receive reperfusion therapy. The objective of this randomized trial was to assess for the first time whether GIK improves myocardial salvage in patients with AMI.
  
  
  METHODS
  The Reevaluation of Intensified Venous Metabolic Support for Acute Infarct Size Limitation (REVIVAL) trial is a randomized, open-label study conducted among 312 patients with AMI. Patients were randomly assigned to either the GIK therapy group (n = 155) or the control group (n = 157). All patients were intended to receive reperfusion treatment, which was given in all but 5 patients (1.6%). The primary end point of the study was salvage index, measured as the proportion of initial perfusion defect (acute technetium-99m sestamibi scintigraphy) salvaged by therapy (follow-up scintigraphy performed after 7 to 14 days).
  
  
  RESULTS
  The primary end point of the study, the salvage index, was in median 0.50 (25th, 75th percentiles: 0.18, 0.87) in the GIK group and 0.48 (25th, 75th percentiles: 0.27, 0.78) in the control group (P =.96). By 6 months, the mortality rate was 5.8% in the GIK group and 6.4% in the control group (P =.85; relative risk, 0.92; 95% CI, 0.37 to 2.26). Subgroup analyses showed that GIK therapy was associated with increased salvage index only among diabetic patients (mean difference, 0.19; 95% CI, 0.01 to 0.37).
  
  
  CONCLUSIONS
  The routine use of GIK therapy in patients with AMI is not associated with enhanced myocardial salvage. This therapy appears to improve myocardial salvage only among diabetic patients.
authors.affiliation: Medizinische Klinik rechts der Isar, Munich, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pache
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.forename: Hildegard
authors.initials: H
authors.lastname: Bollwein
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Helmut
authors.initials: H
authors.lastname: Schühlen
authors.forename: Stefan
authors.initials: S
authors.lastname: Martinoff
authors.forename: Melchior
authors.initials: M
authors.lastname: Seyfarth
authors.forename: Stephan
authors.initials: S
authors.lastname: Nekolla
authors.forename: Josef
authors.initials: J
authors.lastname: Dirschinger
authors.forename: Markus
authors.initials: M
authors.lastname: Schwaiger
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003131:Combined Modality Therapy; D048909:Diabetes Complications; D005260:Female; D005947:Glucose / Q000627:therapeutic use*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011188:Potassium / Q000627:therapeutic use*; D011877:Radionuclide Imaging; D015996:Survival Rate; D015912:Thrombolytic Therapy
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D007328:Insulin; D010975:Platelet Aggregation Inhibitors; D005947:Glucose; D011188:Potassium; D000077284:Abciximab