ST-segment elevation resolution and outcome in patients treated with primary angioplasty and glucose-insulin-potassium infusion.
BACKGROUND
To evaluate the impact of adjunctive high-dose glucose-insulin-potassium (GIK) on ST-segment elevation resolution in patients with ST-segment elevation myocardial infarction (MI).


METHODS
As part of a randomized controlled trial of GIK versus no GIK in patients treated with primary percutaneous coronary intervention (PCI) for ST-elevation MI in a tertiary referral center, we analyzed ST-segment elevation resolution. Paired electrocardiographic recordings (baseline and 3 hours after primary PCI) were available in 612 (65%) of 940 patients.


RESULTS
We analyzed paired electrocardiograms of 310 patients randomized to GIK and 302 control patients. Baseline characteristics of the groups were comparable. Combined complete (>70%) and partial (30%-70%) resolution was more commonly observed in the GIK group (87%) when compared with the control group (78%), odds ratio 1.92 (95% CI 1.23-3.02, P = .004); 1-year mortality was lower in patients with combined complete and partial resolution compared with patients without resolution (3.8% vs 10.3%, P = .011). There was no difference in 1-year mortality between GIK and control patients (5.5% vs 4.3%, P = .58).


CONCLUSIONS
In patients with ST-elevation MI treated with primary PCI, addition of GIK is associated with improved ST-segment elevation resolution. ST-segment elevation resolution is related to improved 1-year survival. No benefit of GIK on 1-year outcome was observed. Future trials should investigate whether GIK-induced improvement of ST-segment elevation resolution results in more favorable clinical outcome.
Department of Cardiology, Thoraxcenter, University Medical Center Groningen, Groningen, The Netherlands. i.c.c.van.der.horst@thorax.umcg.nl
Iwan C C
IC
van der Horst
Giuseppe
G
De Luca
Jan Paul
JP
Ottervanger
Menko-Jan
MJ
de Boer
Jan C A
JC
Hoorntje
Harry
H
Suryapranata
Jan-Henk E
JH
Dambrink
A T Marcel
AT
Gosselink
Felix
F
Zijlstra
Arnoud W J
AW
van 't Hof
D017130:Angioplasty; D004562:Electrocardiography; D005260:Female; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D011188:Potassium / Q000627:therapeutic use
D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium