title: Myocardial protection by glucose-insulin-potassium in acute coronary syndrome patients undergoing urgent multivessel off-pump coronary artery bypass surgery.
abstract: BACKGROUND
  The aim of this randomized and controlled trial was to investigate the effect of a glucose-insulin-potassium (GIK) solution on myocardial protection in acute coronary syndrome (ACS) patients undergoing urgent multivessel off-pump coronary artery bypass (OPCAB) surgery.
  
  
  METHODS
  Sixty-six patients were randomly allocated either to receive 0.3 ml kg(-1) h(-2) GIK solution (potassium 80 mEq and regular insulin 325 IU in 500 ml of 50% glucose) or equivalent volume of normal saline (control) upon anaesthetic induction until 6 h after reperfusion. The primary endpoints were to compare the concentrations of creatine kinase-MB (CK-MB) and troponin-T between the groups after reperfusion. The secondary endpoints were to compare the incidences of postoperative troponin-T >0.8 ng ml(-1) and myocardial infarction (MI) between the groups.
  
  
  RESULTS
  Highest CK-MB [8.7 (4.4) vs 13.1 (7.9) ng ml(-1), P=0.006] and troponin-T [0.20 (0.13-0.49) vs 0.48 (0.18-0.91) ng ml(-1), P<0.0001] values after reperfusion were significantly lower in the GIK group compared with the control group. The area under the curve of serially measured troponin-T was also significantly smaller in the GIK group compared with the control group [0.83 (0.43-1.81) vs 0.46 (0.31-1.00), P=0.036]. Significantly fewer patients in the GIK group showed troponin-T >0.8 ng ml(-1) after reperfusion compared with the control group (3 vs 11, P=0.033). The incidence of postoperative MI was similar between the groups.
  
  
  CONCLUSIONS
  GIK administration in ACS patients undergoing urgent multivessel OPCAB significantly attenuated the degree of ensuing myocardial injury without complications related to glycaemic control. Clinical Trial Registry. URL: http://clinicaltrials.gov/ct2/show/NCT01384656?term=GIK+AND+OPCAB&rank=1. Unique identification number NCT01384656.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University Health System, 250 Seongsanno, Seodaemun-Gu, Seoul 120-752, Republic of Korea.
authors.forename: J-K
authors.initials: JK
authors.lastname: Shim
authors.forename: S-Y
authors.initials: SY
authors.lastname: Yang
authors.forename: Y-C
authors.initials: YC
authors.lastname: Yoo
authors.forename: K-J
authors.initials: KJ
authors.lastname: Yoo
authors.forename: Y-L
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents; D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump; D052279:Creatine Kinase, MB Form / Q000097:blood; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D005947:Glucose / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011188:Potassium / Q000627:therapeutic use*; D020107:Troponin T / Q000097:blood
chemical_list: D002316:Cardiotonic Agents; D007004:Hypoglycemic Agents; D007328:Insulin; D020107:Troponin T; D052279:Creatine Kinase, MB Form; D005947:Glucose; D011188:Potassium