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Background: Admission hyperglycaemia is associated with an increased risk of mortality after myocardial infarction. Whether long-term glucose dysregulation (assessed by HbAic) is more important than acute hyperglycaemia is unknown. We evaluated the prognostic value of admission glucose and HbAic levels in nondiabetic patients with ST-segment elevation acute myocardial infarction (STEMI). Methods: In 504 unselected, consecutive patients with STEMI, glucose and HbAic levels were measured on admission. Glucose was categorised as = 11.1 mmol/l (n=82). HbAic levels were categorised as = 6.0% (n=88). Mean follow-up was 1.6 +/- 0.6 years. Results: Patients with hyperglycaemia on admission were comparable with those with normoglycaernia. However, patients with HbAic >= 6.0%, as compared with those with HbAic = 11.1 mmol/l) was 4% and 19% (p= 6%) was 5% and 12% (p=0.03)After multivariable analyses, admission glucose (OR 4.91, 95% CI 2.03 to 11.9, p

Background To evaluate the impact of adjunctive high-dose glucose-insulin-potassium (GIK) on ST-segment elevation resolution in patients with ST-segment elevation myocardial infarction (MI). Methods As part of a randomized controlled trial of GIK versus no GIK in patients treated with primary percutaneous coronary intervention (PC[) for ST-elevation MI in a tertiary referral center, we analyzed ST-segment elevation resolution. Paired electrocardiographic recordings (baseline and 3 hours after primary PCI) were available in 612 (65%) of 940 patients. Results We analyzed paired electrocardiograms of 3 10 patients randomized to GIK and 302 control patients. Baseline characteristics of the groups were comparable. Combined complete (>70%) and partial (30%-70%) resolution was more commonly observed in the GIK group (87%) when compared with the control group (78%), odds ratio 1.92 (95% Cl 1.23-3.02, P =.004); 1-year mortality was lower in patients with combined complete and partial resolution compared with patients without resolution (3.8% vs 10.3%, P =.0 11). There was no difference in 1-year mortality between GIK and control patients (5.5% vs 4.3%, P =.58). Conclusions In patients with ST-elevation MI treated with primary PCI, addition of GIK is associated with improved ST-segment elevation resolution. ST-segment elevation resolution is related to improved 1-year survival. No benefit of GIK on 1-year outcome was observed. Future trials should investigate whether GIK-induced improvement of ST-segment elevation resolution results in more favorable clinical outcome.

OBJECTIVES In this study we considered the question of whether adjunction of glucose-insuhn-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 greater than or equal to 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 greater than or equal to 2) at admission is uncertain. (C) 2003 by the American College of Cardiology Foundation.

Objectives. In this study we sought to investigate the effect of intervention with captopril within 6 h of the onset of myocardial infarction on left ventricular volume and clinical symptoms of heart failure in relation to infarct size during a 1-year follow-up period. Background. Remodeling of the heart starts in the early phase of myocardial infarction and is associated with an adverse prognosis, Angiotensin-converting enzyme inhibition started in the subacute or late phase after myocardial infarction has been shown to improve prognosis. Methods. In the Captopril and Thrombolysis Study, 298 patients with a first anterior myocardial infarction treated with intravenous streptokinase were randomized to receive either oral captopril (25 mg three times a day) or placebo. The left ventricular volume index was assessed by tao-dimensional echocardiography within 24 h, on days 3, 10 and 90 and after 1 year. Results. A small but significant increase in left ventricular volume indexes was observed after 12 months, Using a random coefficient model, no significant treatment effect on left ventricular volumes could be detected, In contrast, when survival models were used, the occurrence of left ventricular dilation was significantly lower in captopril-treated patients (p = 0.018), In addition, the incidence of heart failure was lower in the captopril group (p