Abstract 13369: Effects of Glucose-Insulin-Potassium Infusion on C-Reactive Protein Levels in Patients With an Acute Coronary Syndrome
The clinical benefits of intravenous glucose-insulin-potassium (GIK) observed in acute coronary syndromes (ACS) may in part be due to an anti-inflammatory effect. The IMMEDIATE Trial compared out-of-hospital emergency medical service-administered GIK to placebo for progression of ACS to myocardial infarction. Using data from the IMMEDIATE Trial biological mechanism cohort on those with confirmed ACS and who received study drug for at least 8 hours (N=143), we assessed the impact of GIK administration on C-reactive protein (CRP) levels in patients within the first 12 hours of drug infusion. We hypothesized that GIK would reduce CRP levels and that differences in CRP levels would be associated with ultimate infarct size. High sensitivity CRP (hs-CRP) was measured at hospital presentation, soon after infusion initiation, and at 6 and 12 hours. Infarct size was measured at 30 days by sestamibi SPECT scan. Independent sample t-test and random mixed effect models were used to estimate differences in hs-CRP levels; the association between infarct size and hs-CRP, was analyzed by univariate and multivariable regression. Of 143 participants, 68 were given GIK and 75 placebo. Log hs-CRP measurements increased significantly in both the control and the treatment groups over time (P<0.01 for all intragroup comparisons). A borderline difference in log hs-CRP values was observed at the 12-hour measurements in GIK group vs. placebo (mean =1.5 in GIK and 1.94 in placebo; P=0.05). A significant increase in CRP over time did not differ between treatment arms (P for time*treatment interaction =0.3). There was no significant association between CRP and infarct size at any time measurement (for the 12 hour measurement, β= 5.9, P=0.1). In conclusion, in this sample of patients with ACS, the significant increase in CRP levels in the first 12 hours of an infarct suggests an active inflammatory state. Early administration of GIK is associated with reduced CRP levels, supportive of GIK having an anti-inflammatory effect; however, the change in CRP does not correlate with infarct size.
- © 2013 by American Heart Association, Inc.