on February 2, 2004
Circulation. 2004
Published online before print February 2, 2004, doi: 10.1161/01.CIR.0000116762.77804.FC
Published online before print February 2, 2004, doi: 10.1161/01.CIR.0000116762.77804.FC
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Submitted on September 16, 2003
From the Division of Endocrinology, Diabetes and Metabolism, State University of New York at Buffalo, and Kaleida Health (A.C., D.T., R.G., A.B., D.H., T.S., H.G., A.A., P.D.); Division of Cardiology, SUNY Buffalo, Kaleida Health (M.F.W.); MFHS Physicians Emergency Services, Department of Emergency Medicine, SUNY Buffalo (D.J.); and Department of Emergency Medicine, Kaleida Health (J.C.), Buffalo, NY. * To whom correspondence should be addressed. E-mail: pdandona{at}kaleidahealth.org.
Background--The clinical benefits of insulin previously observed in acute ST-segment-elevation myocardial infarction (STEMI) may be partially explained by an anti-inflammatory effect. We assessed this potential effect of insulin in STEMI patients treated with fibrinolytics. Methods and Results--Thirty-two patients receiving reteplase were randomly assigned infusions of either insulin at 2.5 U/h, dextrose, and potassium (GIK) or normal saline and potassium (C) for 48 hours. Plasma concentrations of high-sensitivity C-reactive protein (CRP), serum amyloid A (SAA), plasminogen activator inhibitor-1 (PAI-1), creatine kinase (CK), and CK-MB were measured at baseline and sequentially for 48 hours. Total p47phox protein in mononuclear cells was measured in a subgroup of 13 subjects. Baseline CRP and SAA were significantly increased (2- to 4-fold) at 24 and 48 hours in each group (P<0.01). However, in the insulin group, there was a significant (P<0.05) attenuation of the absolute rise in concentration of CRP and SAA from baseline. The absolute increase of CRP and SAA was reduced by 40% (CRP) and 50% (SAA) at 24 hours and at 48 hours compared with the control group. The absolute increase in PAI-1 from baseline and the percentage increase in p47phox over 48 hours were significantly (P<0.05) lower in the insulin-treated group. CK-MB peaked earlier and tended to be lower in insulin-treated subjects, especially in patients with inferior MI. Conclusions--Insulin has an anti-inflammatory and profibrinolytic effect in patients with acute MI. These effects may contribute to the clinical benefits of insulin in STEMI.
Revised on November 7, 2003
Accepted on November 18, 2003
Anti-Inflammatory and Profibrinolytic Effect of Insulin in Acute ST-Segment-Elevation Myocardial Infarction
Ajay Chaudhuri MBBS, MRCP,
Key words: myocardial infarction • inflammation • insulin • atherosclerosis
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|
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|
|
|
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|
|
|
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|
|
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|
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|
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|
|
|
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|
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|
|
|
|
|
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|
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