Abstract 12942: Modified Glucose-Insulin-Potassium Regimen Provides Cardiac and Renal Protection With Improved Tissue Perfusion and Metabolism in Patients Undergoing Cardiopulmonary Bypass Surgery
Background: Laboratory studies demonstrate glucose-insulin-potassium (GIK) as a potent cardioprotective intervention but clinical trials have yielded mixed results, presumably due to varying formulas and treatment timing of GIK. This study evaluated the effects of modified GIK given perioperatively in patients undergoing cardiopulmonary bypass (CPB) surgery.
Methods and Results: In this prospective, randomized, double-blinded trial with 930 patients, 750 mL GIK (200 g/L glucose, 66.7 U/L insulin and 80 mmol/L KCl) or placebo treatment was administered intravenously at 1 mL/kg/h 10 min before anesthesia. The primary outcome was the incidence of major adverse cardiac events (MACE). No significant difference in mortality was observed between the two groups. GIK therapy reduced the incidence of MACE (OR, 0.57; 95% CI, 0.43-0.75; P<0.001), enhanced cardiac function recovery with better glucose controlled without increasing perioperative blood glucose compared with placebo group. These benefits were associated with increased glucose uptake (9.5±4.6% vs. 5.6±2.6% in Placebo, P=0.005) and less lactate excretion (8.4 ± 9.2% vs. 33.4 ± 22.6% in Placebo, P<0.001) evidenced by the difference between arterial and coronary sinus, more glycogen store analyzed by transmission electron micrograph, and increased phosphorylation of IRS-1 and Akt in the hearts of GIK-treated patients. Importantly, GIK therapy significantly reduced blood lactate at 1 h, 6 h and 12 h after operation compared with placebo group (all P<0.001), indicating a enhanced tissue perfusion during CPB. Accordingly, patients treated with GIK had decreased markers of renal and hepatic injury, lower incidences of acute kidney injury and extended intensive care.
Conclusions: Modified GIK regimen administrated perioperatively reduced the incidence of MACE and preserved cardiac and renal function in patients undergoing CPB surgery. These benefits were associated with activation of insulin signaling, improved myocardial metabolism and enhanced systemic tissue perfusion afforded by GIK.
- cardiopulmonary bypass
- major adverse cardiac events
- tissue perfusion
- renal function
Author Disclosures: J. Li: None. K. Zhao: None. Y. Zhang: None. Q. Cui: None. R. Zhao: None. J. Yang: None. S. Yu: None. D. Yi: None. F. Gao: None.
- © 2015 by American Heart Association, Inc.