Effects of glucose-insulin-potassium infusion on myocardial perfusion and left ventricular remodeling in patients treated with primary angioplasty for ST-elevation acute myocardial infarction.
The role of glucose-insulin-potassium (GIK) infusion in the management of acute coronary syndrome is controversial. Limited data are available on the effects of adjunctive high-dose GIK (30% glucose, 50 IU of insulin, 80 mEq of potassium chloride infused at 1.5 ml/kg/hour over 24 hours) on myocardial perfusion and left ventricular (LV) remodeling in patients treated with primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction. In this prospective study, 73 patients were randomized to receive GIK infusion (n = 40) or saline (placebo, n = 33) in addition to standard therapy. The primary end points were myocardial perfusion after PCI and LV remodeling at 6 months. Thrombolysis In Myocardial Infarction frame count and myocardial blush grade were evaluated before and after reperfusion treatment. LV end-diastolic and end-systolic volumes, ejection fraction, and wall motion score index were assessed in each patient after PCI and after 6 months. Although no differences in final Thrombolysis In Myocardial Infarction flow were observed between the 2 groups, myocardial blush grade 3 was more frequently achieved in the GIK group (p <0.05). At 6 months, ventricular remodeling was more often observed in the control group (24% vs 3%, p <0.05). In conclusion, GIK infusion in adjunct to primary PCI in patients with ST-segment elevation myocardial infarction was safe, improved myocardial perfusion after revascularization, and was associated with less LV remodeling at follow-up.
Bucciarelli-Ducci
Chiara
C
Department of Cardiovascular and Respiratory Sciences, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy. chiara.bucciarelli@uniroma1.it
Bianchi
Maria
M
De Luca
Leonardo
L
Battagliese
Alessandro
A
Di Russo
Cristian
C
Proietti
Paola
P
Vizza
Carmine D
CD
Fedele
Francesco
F
D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000628:therapy*; D010865:Pilot Projects; D011188:Potassium / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000187:drug effects*
D007328:Insulin; D005947:Glucose; D011188:Potassium