Effect of perioperative glucose-insulin-potassium infusions on mortality and atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis.
BACKGROUND
Glucose-insulin infusions (with potassium [GIK] or without [GI]) have been advocated in the setting of coronary artery bypass graft (CABG) surgery to optimize myocardial glucose use and to minimize ischemic injury.


OBJECTIVE
To conduct a meta-analysis assessing whether the use of GIKGI infusions perioperatively reduce in-hospital mortality or atrial fibrillation (AF) after CABG surgery.


METHODS
Electronic databases (Medline, EMBASE and Cochrane Central Register of Controlled Trials [CENTRAL]) and references of retrieved articles were searched for randomized controlled trials that evaluated the effects of GIK or GI infusions, before or during CABG surgery, on in-hospital mortality andor postoperative AF. Pooled ORs and 95% CIs were calculated for each outcome.


RESULTS
Twenty trials were identified and eligible for review. The summary OR for in-hospital mortality was 0.88 (95% CI 0.56 to 1.40), based on 44 deaths among 2326 patients. While postoperative AF was a more frequent outcome (occurring in 519 of 1540 patients in the 10 trials reporting this outcome), the overall pooled estimate of effect was nonsignificant (OR 0.79, 95% CI 0.54 to 1.15). This latter finding needs to be interpreted cautiously because it is accompanied by significant heterogeneity across trials.


CONCLUSIONS
Perioperative use of GIKGI does not significantly reduce mortality or atrial fibrillation in patients undergoing CABG surgery. Unless future trial data in support of GIKGI infusions become available, the routine use of these treatments in patients undergoing CABG surgery should be discouraged because the safety of these infusions has not been systematically examined.
Rabi
Doreen
D
Department of Medicine, University of Calgary, Calgary, Canada. doreen.rabi@calgaryhealthregion.ca
Clement
Fiona
F
McAlister
Finlay
F
Majumdar
Sumit
S
Sauve
Reg
R
Johnson
Jeffrey
J
Ghali
William
W
D000416:Alberta / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D002314:Cardioplegic Solutions; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000601:surgery; D005947:Glucose / Q000008:administration & dosage; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage; D011188:Potassium / Q000008:administration & dosage; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium