Safety and efficacy of glucose-insulin-potassium treatment in coronary artery bypass graft surgery and percutaneous coronary intervention.
The purpose of this meta-analysis was to evaluate protective effects of glucose-insulin-potassium (GIK) on outcomes after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). We systematically searched Medline/Pubmed, Elsevier, Embase, Web of Knowledge and Google Scholar. A total of 1206 studies were retrieved during the extensive literature search of all major databases; however, 38 trials reporting the end-point of interest were selected. We performed a pooled analysis of outcomes following PCI: incidence of cardiac arrest [odds ratio (OR) of 0.91; 95% confidence interval (CI): 0.76-1.09; P = 0.3], stroke (OR of 1.71; 95% CI: 0.37-1.37; P = 0.3), cardiogenic shock (OR of 1.02; 95% CI: 0.92-1.14; P = 0.6), reinfarction (OR of 0.95; 95% CI: 0.81-1.14; P = 0.5) and mortality (OR of 1.04; 95% CI: 0.96-1.13; P = 0.3); and following CABG: incidence of atrial fibrillation (OR of 0.86; 95% CI: 0.70-1.05; P = 0.1), incidence of ventricular fibrillation (OR of 0.83; 95% CI: 0.62-1.13; P = 0.2), reinfarction (OR of 0.97; 95% CI: 0.74-1.27; P = 0.8), infection (OR of 1.04; 95% CI: 0.67-1.62; P = 0.8), length of intensive care unit stay (LIS) [standard mean differences (SMD) of -0.27; 95% CI: -0.40 to -0.14; P = 0.000], length of hospital stay (LHS) (SMD of -0.035; 95% CI: -0.12 to -0.05; P = 0.4) and mortality (OR of 0.72; 95% CI: 0.41-1.26; P = 0.2). Our results showed that GIK did not have considerable cardioprotective effects. However, patients undergoing CABG seem to be better responders to GIK therapy compared with patients undergoing PCI. Furthermore, in contrast to CABG, GIK therapy in patients undergoing PCI might be associated with more complications rather than protective effects.
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Sadegh
S
Ali-Hassan-Sayegh
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Seyed Jalil
SJ
Mirhosseini
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
Mohamed
M
Zeriouh
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Ali Mohammad
AM
Dehghan
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Arezoo
A
Shahidzadeh
Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Ali Akbar
AA
Karimi-Bondarabadi
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK a.sabashnikov@gmail.com.
Anton
A
Sabashnikov
Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
Aron-Frederik
AF
Popov
D002314:Cardioplegic Solutions; D001026:Coronary Artery Bypass; D014943:Global Health; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011188:Potassium / Q000627:therapeutic use
D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium
Atrial fibrillation; Clinical outcome; Coronary artery bypass graft; Glucose–insulin–potassium; Myocardial infarction; Percutaneous coronary intervention