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J Am Coll Cardiol, 2003; 42:784-791, doi:10.1016/S0735-1097(03)00830-1 © 2003 by the American College of Cardiology Foundation |
,*
* Department of Cardiology, Isala Klinieken, Hospital de Weezenlanden, Zwolle, The Netherlands
Department of Internal Medicine, Isala Klinieken, Hospital de Weezenlanden, Zwolle, The Netherlands
Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands
Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands
|| Department of Clinical Epidemiology, University Medical Center, Leiden, The Netherlands
Manuscript received November 19, 2002; revised manuscript received March 9, 2003, accepted March 20, 2003.
* Reprint requests and correspondence: Dr. Felix Zijlstra, Department of Cardiology, University Hospital Groningen, Hanzeplein 1, Postbus 30.001, 9700 RB Groningen, The Netherlands.
f.zijlstra{at}thorax.azg.nl
OBJECTIVES: In this study we considered the question of whether adjunction of glucose-insulin-potassium (GIK) infusion to primary coronary transluminal angioplasty (PTCA) is effective in patients with an acute myocardial infarction (MI).
BACKGROUND: A combined treatment of early and sustained reperfusion of the infarct-related coronary artery and the metabolic modulation with GIK infusion has been proposed to protect the ischemic myocardium.
METHODS: From April 1998 to September 2001, 940 patients with an acute MI and eligible for PTCA were randomly assigned, by open-label, to either a continuous GIK infusion for 8 to 12 h or no infusion.
RESULTS: The 30-day mortality was 23 of 476 patients (4.8%) receiving GIK compared with 27 of 464 patients (5.8%) in the control group (relative risk [RR] 0.82, 95% confidence interval [CI] 0.46 to 1.46). In 856 patients (91.1%) without signs of heart failure (HF) (Killip class 1), 30-day mortality was 5 of 426 patients (1.2%) in the GIK group versus 18 of 430 patients (4.2%) in the control group (RR 0.28, 95% CI 0.1 to 0.75). In 84 patients (8.9%) with signs of HF (Killip class 
2), 30-day mortality was 18 of 50 patients (36%) in the GIK group versus 9 of 34 patients (26.5%) in the control group (RR 1.44, 95% CI 0.65 to 3.22).
CONCLUSIONS: Glucose-insulin-potassium infusion as adjunctive therapy to PTCA in acute MI did not result in a significant mortality reduction in all patients. In the subgroup of 856 patients without signs of HF, a significant reduction was seen. The effect of GIK infusion in patients with signs of HF (Killip class 2) at admission is uncertain.
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