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(Circulation. 1997;96:1152-1156.)
© 1997 American Heart Association, Inc.
Articles |
Glucose-Insulin-Potassium Therapy for Treatment of Acute Myocardial Infarction
An Overview of Randomized Placebo-Controlled Trials
From the Medical Research Council Clinical Sciences Centre (F.F.-O.), Postgraduate Medical School, and Department of Cardiology (F.F.-O., K.J.B.), Hammersmith Hospital, London, UK.
Background Glucose-insulin-potassium (GIK) therapy has been advocated for the treatment of acute myocardial infarction. However, the results from the clinical trials have been inconclusive, largely because of the small number of patients recruited and discrepancies between protocols used in these studies.
Method and Results A systematic MEDLINE search for all the randomized placebo-controlled studies of GIK therapy in acute myocardial infarction was made, and a meta-analysis of the mortality data was performed. Fifteen trials were identified, 5 were excluded because of poor randomization, and 1 was excluded because recruitment was limited to diabetic patients. The 9 remaining trials with a total of 1932 patients were included in the analysis. Hospital mortality was reduced from 21% (205 of 972 patients) in the placebo group to 16.1% (154 of 956) in the GIK group (P=.004; odds ratio, 0.72; 95% confidence interval [CI], 0.57 to 0.90). The proportional mortality reduction was 28% (CI, 10% to 43%). The number of lives saved per 1000 patients treated was 49 (95% CI, 14 to 83).
Conclusions The findings indicate that GIK therapy may have an important role in reducing the in-hospital mortality after acute myocardial infarction. The value of this therapy in the era of thrombolysis and acute revascularization by primary angioplasty can be fully resolved only by conducting a large randomized mortality study.
Key Words: glucose • myocardial infarction • insulin • metabolism • meta-analysis
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M. N. Sack and D. M. Yellon Insulin therapy as an adjunct toreperfusion after acute coronary ischemia: A proposed direct myocardial cell survival effect independent of metabolic modulation J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1404 - 1407. [Abstract] [Full Text] [PDF]
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J. G. Bovill Anesthesia for Patients with Impaired Ventricular Function Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 49 - 54. [PDF]
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H. B. van Wezel and S. W. M. d. Jong Clinical Use of Glucose-Insulin-Potassium in Cardiac Surgery andAcute Myocardial Infarction: An Overview Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 77 - 83. [PDF]
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C. J. Tack Insulin Resistance and Acute Cardiovascular Complications Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 85 - 90. [PDF]
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T. Doenst, W. Bothe, and F. Beyersdorf Therapy with insulin in cardiac surgery: controversies and possible solutions Ann. Thorac. Surg., February 1, 2003; 75(2): S721 - 728. [Abstract] [Full Text] [PDF]
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J. Sundell and J. Knuuti Insulin and myocardial blood flow Cardiovasc Res, February 1, 2003; 57(2): 312 - 319. [Abstract] [Full Text] [PDF]
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The Task Force on the Management of Acute Myocardi, F. Van de Werf, D. Ardissino, A. Betriu, D. V. Cokkinos, E. Falk, K. A.A. Fox, D. Julian, M. Lengyel, F.-J. Neumann, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation Eur. Heart J., January 1, 2003; 24(1): 28 - 66. [Full Text] [PDF]
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R. Ferrara, G. Guardigli, and R. Ferrari Myocardial metabolism: the diabetic heart Eur. Heart J. Suppl., January 1, 2003; 5(suppl_B): B15 - B18. [Abstract] [PDF]
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N. N. Wahab, E. A. Cowden, N. J. Pearce, M. J. Gardner, H. Merry, J. L. Cox, and ICONS Investigators Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1748 - 1754. [Abstract] [Full Text] [PDF]
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L. Ryden and K. Malmberg Who are the enemies? Diabetes mellitus -- a major risk factor for ischaemic myocardial injury: new directions in the management of acute coronary syndromes in the diabetic patient Eur. Heart J. Suppl., November 1, 2002; 4(suppl_G): G21 - G25. [Abstract] [PDF]
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J. L. Carson, P. M. Scholz, A. Y. Chen, E. D. Peterson, J. Gold, and S. H. Schneider Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery J. Am. Coll. Cardiol., August 7, 2002; 40(3): 418 - 423. [Abstract] [Full Text] [PDF]
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I. B. Hirsch, A. Coviello, J. E. Mazuski, J. A. Bailey, M. J. Shapiro, K. C. McCowen, J. A. Maykel, B. R. Bistrian, N. J. Nusbaum, G. van den Berghe, et al. Intensive Insulin Therapy in Critically Ill Patients N. Engl. J. Med., May 16, 2002; 346(20): 1586 - 1588. [Full Text] [PDF]
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W. A. Lell, V. G. Nielsen, D. C. McGiffin, F. E. Schmidt Jr, J. K. Kirklin, and A. W. Stanley Jr Glucose-insulin-potassium infusion for myocardial protection during off-pump coronary artery surgery Ann. Thorac. Surg., April 1, 2002; 73(4): 1246 - 1251. [Abstract] [Full Text] [PDF]
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J. Sundell, P. Nuutila, H. Laine, M. Luotolahti, K. Kalliokoski, O. Raitakari, and J. Knuuti Dose-Dependent Vasodilating Effects of Insulin on Adenosine-Stimulated Myocardial Blood Flow Diabetes, April 1, 2002; 51(4): 1125 - 1130. [Abstract] [Full Text] [PDF]
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I. B. Hirsch In-Patient Hyperglycemia--Are We Ready to Treat It Yet? J. Clin. Endocrinol. Metab., March 1, 2002; 87(3): 975 - 977. [Full Text] [PDF]
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Q. Liu, J. C. Docherty, J. C. T. Rendell, A. S. Clanachan, and G. D. Lopaschuk High levels of fatty acids delay the recoveryof intracellular pH and cardiac efficiency inpost-ischemic hearts by inhibiting glucose oxidation J. Am. Coll. Cardiol., February 20, 2002; 39(4): 718 - 725. [Abstract] [Full Text] [PDF]
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T. Ramanathan, K. Shirota, S. Morita, T. Nishimura, Y. Huang, and S. N. Hunyor Glucose-insulin-potassium solution improves left ventricular mechanics in diabetes Ann. Thorac. Surg., February 1, 2002; 73(2): 582 - 587. [Abstract] [Full Text] [PDF]
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H.-P. Hermann, O. Zeitz, S. E Lehnart, B. Keweloh, N. Datz, G. Hasenfuss, and P. M.L Janssen Potentiation of beta-adrenergic inotropic response by pyruvate in failing human myocardium Cardiovasc Res, January 1, 2002; 53(1): 116 - 123. [Abstract] [Full Text] [PDF]
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I. B. A. Menown and A. A. J. Adgey Cardioprotective therapy and sodium-hydrogen exchange inhibition: current concepts and future goals J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1651 - 1653. [Full Text] [PDF]
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R. Ramasamy, Y. Hwang, S. Bakr, and S. R. Bergmann Protection of ischemic hearts perfused with an anion exchange inhibitor, DIDS, is associated with beneficial changes in substrate metabolism Cardiovasc Res, August 1, 2001; 51(2): 275 - 282. [Abstract] [Full Text] [PDF]
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I. Gustafsson and P. Hildebrandt Blood glucose in the CCU: time to measure Eur. Heart J., July 1, 2001; 22(13): 1061 - 1062. [PDF]
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