Articles about Glucose-Insulin-Potassium
solution for Cardiovascular Disease
modulation of acute myocardial infarction.
by Diaz R. Critical Care Clinics 2001
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
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
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.
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