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Articles about Glucose-Insulin-Potassium solution for Cardiovascular Disease

Metabolic modulation of acute myocardial infarction.  by Diaz R.  Critical Care Clinics 2001 Apr;17(2):469-76
PubMed abstract:
Acute myocardial infarction continues to be the major determinant of death and disability in Western countries. Despite large improvements in management during the last 20 years, its high morbidity and mortality rates provide a stimulus to search intensively for
different and widely applicable therapeutic options.

Glucose-insulin-potassium (GIK) for acute myocardial infarction: a negative study with a positive value. by Apstein CS, Opie LH.  Cardiovasc Drugs and Therapy 1999 May;13(3):185-9
PubMed abstract:
Glucose-insulin-therapy for acute myocardial infarction (AMI) has had a long history, going back 37 years to the pioneering concepts of Sodi-Pallares. Although a recent meta-analysis of a number of smaller trials has suggested mortality benefit, it is only the South American trial, published in Circulation in 1998, that has been large enough to show a mortality benefit of GIK infusions when compared with controls in the same trial. In contrast, the Polish study published in this issue of this journal produced a negative result. The two chief differences between the studies are the much higher risk of mortality of the patients chosen for the positive trial, and the much higher dose of GIK that was used. Despite this positive trial information, and the very extensive experimental background (which is here reviewed), the present data are not firm nor extensive enough to support the routine use of GIK in patients with AMI. Thus more trials based on the concepts of metabolic therapy are required and are being organized. At present, a careful strategy of patient selection is advocated. In the case of diabetics with AMI, current evidence is already strong enough to recommend routine use of modified GIK for all such patients.

Low-dose glucose-insulin-potassium is ineffective in acute myocardial infarction: results of a randomized multicenter Pol-GIK trial. by Ceremuzynski L et al.  Cardiovasc Drugs and Therapy 1999 May;13(3):191-200.
PubMed abstract:
We aimed to assess the clinical efficacy of glucose-insulin-potassium (GIK) in acute myocardial infarction. Experimental data provided evidence of the beneficial effects of GIK on ischemic myocardium. The clinical trials, mostly uncontrolled and conducted mainly before the thrombolytic era, were inconclusive due to the small number of patients and discrepancies in protocols. In order to evaluate the efficacy of this intervention, we have performed a prospective multicenter randomized study. The study consisted of 954 patients with acute myocardial infarction (MI) randomized within 24 hours from the onset of symptoms to low-dose GIK (n = 494), which consisted of 1000 mL 10% dextrose, 32-20 U insulin, and 80 mEq K-, or to the control group (n = 460), which was given 1000 mL 0.89% sodium chloride, by intravenous 24-hour infusion at a rate of 42 mL/h. Cardiac mortality and the occurrence of cardiac events at 35 days did not differ between GIK and control-allocated patients (32 (6.5%) vs. 21 (4.6%), respectively; OR 1.45, 95% CI 0.79-2.68, P = 0.20; and 214 (43.3%) vs. 192 (41.7%), OR 1.07, 95% CI 0.82-1.38, P = 0.62). Total mortality at 35 days was significantly higher in the GIK than in the control group (44 (8.9%) vs. 22 (4.8%), respectively, OR 1.95, 95% CI 1.12-3.47, P = 0.01). The excess of non-cardiac deaths in the GIK group may have occurred by chance. Low-dose GIK treatment does not improve the survival and clinical course in acute MI.
 

Glucose-Insulin-Potassium for Acute Myocardial Infarction -- Remarkable Results From a New Prospective, Randomized Trial [editorial] by Carl S. Apstein.  Circulation. 1998 98(21):2223-2226.  (no abstract)

Metabolic Modulation of Acute Myocardial Infarction -- The ECLA Glucose-Insulin-Potassium Pilot Trial  by Diaz R, Paolasso EA, Piegas LS, Tajer CD, Moreno MG, Corvalan R, Isea JE, Romero G.  Circulation. 1998 98(21):2227-2234.
Department of Cardiology, Instituto Cardiovascular de Rosario, Rosario, Argentina.
PubMed abstract:
BACKGROUND: Several trials have been performed in the past using glucose, insulin, and potassium infusion (GIK) for the treatment
of acute myocardial infarction (AMI). Because of continuing uncertainty about the potential role of this therapeutic intervention, we
conducted a randomized trial to evaluate the impact of a GIK solution during the first hours of AMI. METHODS AND RESULTS:
Four hundred seven patients with suspected AMI admitted within 24 hours of symptoms onset were enrolled. In a ratio of 2:1, 268
patients were allocated to receive GIK (high- or low-dose) and 139 to receive control. Phlebitis and serum changes in the plasma
concentration of glucose or potassium were observed more often with GIK. A trend toward a nonsignificant reduction in major and
minor in-hospital events was observed in patients allocated to GIK. In 252 patients (61.9%) treated with reperfusion strategies, a
statistically significant reduction in mortality (relative risk [RR] 0.34; 95% CI: 0.15 to 0.78; 2P=0.008) and a consistent trend toward
fewer in-hospital events in the GIK group were observed. CONCLUSIONS: Our results confirm that a metabolic modulation strategy
in the first hours of an AMI is feasible, applicable worldwide, and has mild side effects. The statistically significant mortality reduction in
patients who underwent a reperfusion strategy might have important implications for the management of AMI patients. It is now
essential to perform a large-scale trial to reliably determine the magnitude of benefit.
 

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