The impact of glucose-insulin-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction [ISRCTN56720616].
BACKGROUND
Favorable clinical outcomes have been observed with glucose-insulin-potassium infusion (GIK) in acute myocardial infarction (MI). The mechanisms of this beneficial effect have not been delineated clearly. GIK has metabolic, anti-inflammatory and profibrinolytic effects and it may preserve the ischemic myocardium. We sought to assess the effect of GIK infusion on infarct size and left ventricular function, as part of a randomized controlled trial.


METHODS
Patients (n = 940) treated for acute MI by primary percutaneous coronary intervention (PCI) were randomized to GIK infusion or no infusion. Endpoints were the creatinine kinase MB-fraction (CK-MB) and left ventricular ejection fraction (LVEF). CK-MB levels were determined 0, 2, 4, 6, 24, 48, 72 and 96 hours after admission and the LVEF was measured before discharge.


RESULTS
There were no differences between the two groups in the time course or magnitude of CK-MB release: the peak CK-MB level was 249 +/- 228 U/L in the GIK group and 240 +/- 200 U/L in the control group (NS). The mean LVEF was 43.7 +/- 11.0 % in the GIK group and 42.4 +/- 11.7% in the control group (P = 0.12). A LVEF < or = 30% was observed in 18% in the controls and in 12% of the GIK group (P = 0.01).


CONCLUSIONS
Treatment with GIK has no effect on myocardial function as determined by LVEF and by the pattern or magnitude of enzyme release. However, left ventricular function was preserved in GIK treated patients.
van der Horst
Iwan C C
IC
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. i.c.c.van.der.horst@thorax.umcg.nl
Ottervanger
Jan Paul
JP
van 't Hof
Arnoud W J
AW
Reiffers
Stoffer
S
Miedema
Kor
K
Hoorntje
Jan C A
JC
Dambrink
Jan-Henk E
JH
Gosselink
A T Marcel
AT
Nijsten
Maarten W N
MW
Suryapranata
Harry
H
de Boer
Menko-Jan
MJ
Zijlstra
Felix
F
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003402:Creatine Kinase / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D011188:Potassium / Q000008:administration & dosage; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*
D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D003402:Creatine Kinase; D005947:Glucose; D011188:Potassium