1. ST-segment elevation resolution and outcome in patients treated with primary angioplasty and glucose-insulin-potassium infusion
- Author
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van der Horst, ICC, De Luca, G, Ottervanger, JP, de Boer, MJ, Hoorntje, JCA, Suryapranata, H, Gosselink, ATM, Zijlstra, F, van 't Hof, AWJ, Dambrink, Jan Hendrik Everwijn, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), and Cardiovascular Centre (CVC)
- Subjects
ACUTE MYOCARDIAL-INFARCTION ,INCREASED GLYCOLYTIC SUBSTRATE ,SUCCESSFUL REPERFUSION ,METABOLIC MODULATION ,BLOOD-FLOW ,CORONARY REPERFUSION ,FREE FATTY-ACIDS ,NONINVASIVE METHOD ,RANDOMIZED-TRIAL ,DIABETIC-PATIENTS - Abstract
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.
- Published
- 2005