1. Effect of Glucose-Insulin-Potassium Infusion on Mortality in Patients With Acute ST-Segment Elevation Myocardial Infarction
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H. Ge, A. Gentile, H. Yang, X. Guo, H. Bai, R. B. Panwar, R. Crivello, V. E. Shegokar, Supriya Patil, X. Sun, M. Y. Bai, Sonia Gupta, S. Shanmugasundaram, D. X. Li, S. Dwivedi, J. P. Albisu, N. Dinesh, R. Liu, Rajvir Singh, S. M. Macin, J. Tang, H. Tan, K. Wang, S. Jia, L. L. Lobo Marquez, C. Baigent, K. Varghese, S. T. Zhang, Prafulla Kerkar, A. V. Bindu, R. Umrani, P. Yang, S. Sanghvi, F. Wang, Z. X. Liu, S. Tredici, Y. Cao, I. Tsuluca, Ratnakar, W. G. Li, N. Chidambaram, P. J. Nathani, Ravi Mehrotra, D. Qiao, A. S. Jain, S. S. Fatima, P. Baselga, D. Wojdyla, Sudhir Naik, J. B. Bijapure, J. Fu, Q. Zhang, Z. Ma, X. Xu, J. Srinivas, Jun Zhu, O. Pellizon, J. Martinez Sanchez, P. Castro, R. E. Ledesma, U. Legler, Q. Cui, Janice Pogue, M. Chenniappan, N. F. Zho, Atanu Biswas, C. M. Yang, M. Garrido, D. Duggal, Shamir R. Mehta, E. Hernandez Leyva, C. E. Girino, N. Wang, Z. Fang, R. Udaysankar, S. C. Manchanda, G. Wang, X. Zhao, R. Monti, H. R. Devendrappa, Harvey D. White, J. Rajesh, J. Wei, N. Wu, R. K. Tongia, L. R. Cartasegna, E. M. Good God, S. Fan, C. Zai, E. Carrillo, S. N. Ferreyra Cantante, R. J. Ahmed, J. Prajapati, X. Hao, M. Fulwani, S. K. Rane, B. S.V. Raj, D. Freeda, J. Bono, A. J. Gambarte, G. Reis, S. Dong, Amal Kumar Khan, Z. R. Tian, M. S. Rao, Denis Xavier, Rinku Sharma, Y. Q. Jiang, B. K.S. Sastry, Y. Wang, V. S. Reddy, X. Yin, G. S.R. Murthy, W. Li, M. G. Yang, DC Rao, M. J. Santhosh, F. Huo, A. K. Maity, T. Wang, J. A. Sanchez, Prem Pais, J L Ramos, S. R. Mehta, S. Y. Lang, P. Gandhimadhinathan, K. K. Haridas, Sanjoy K. Paul, J. Shao, L. H. Wang, S. Mehrotra, S. Wang, B. Isaac, Pradeep Kumar, Luiz Carlos Bodanese, S. Zhang, X. Zhang, Job E. Lopez, C. Becerra, S. S. Iyengar, V. K. Puri, L. S. Zhou, F. Guan, R. Kishore, A. Nambiar, Kadir González, S. Y. Fu, S. Pavlov, R. Pitarch Flors, B. M. Lombana, X. Jiang, G. F. Xie, B. S. Raju, E. Assanelli, P. Nyayadhish, Abdul Hameed, Shriprakash Kalantri, U. Magin, V. S.P. Rao, D. F. Li, C. Y. Liu, E. B. Manoj, Z. Wang, L. Liu, D. M. Mello Soares, K. Soomro, H. Zhang, G. J. Yang, A. Puri, R. Zhqo, A. A. Fernandez, S. Raghavan, J. C. Zhou, W. Zhang, I. Chandna, T. Yang, S. C. Xu, J. Li, M. Zhao, J. Zhang, L. Hao, R. F. Ramos, R. Rajaram, S. Shang, Y. Yang, G. Verma, G. Tao, Y. Miao, P. Castro Galvez, H. Ma, R. Ma, N. L. Sun, E. M. Avila, A. Kalla, S. Ren, C. R. Castellanos, J. Boben, X. You, R. Beniwal, Z. Nan, R. J. Barcudi, Changchun Xie, S. Lidwin, P. R. Nayak, S. S. Ramesh, Cláudia B.R. Martinez, Z. D. Wu, A. Caccavo, Javed Tai, Y. Han, Y. S. Wu, D. Hu, Sharad Chandra, P. B. Latha, Y. Tu, S. Chen, A. Garg, D. Q. An, K. J. Nesaraj, M. Alcaino, X. C. Xu, S. P. Ma, L. Cronin, J. J. Cui, L. Marsano, P. Sleight, H. Saad, H. Liu, Alvaro Avezum, F. Torres, O. P. Soni, G. K. Aneja, Rafael Diaz, R. Guo, H. ul Banna, B. Srinivasulu, Q. F. Zhang, S. Yusuf, J. Zhu, H. S. Yang, W. Wang, P. Ramesh, D. Agnelli, J. Liu, X. Y. Shi, Salim Yusuf, S. K. Trivedi, S. G. Yang, Darren K. McGuire, W. K. Li, H. L. Luciardi, Q. Li, G. Huang, F. Van de Werf, J. Huang, S. B. Siwach, I. Rasool, Q. Zheng, X. Chi, Álvaro Pascual, E. Marzetti, Antonio Carlos Carvalho, Y. Zhang, M. A. Alvarez, S. D. Zawar, Johny Joseph, Y. C. Song, C. B. Xu, C. He, Bateshwar Prasad Singh, R. J. Freedman, Ramón Corbalán, C. Cheng, R. Trehan, S. L. Tungikar, P. Pais, P. K. Shetty, Z. R. Lu, Pradeep Joshi, M. Molec, L. Prestes, C. A. Cuneo, Ernesto Paolasso, Y. Q. Li, S. Rehman, J. Ma, Wael Almahmeed, M. A. Berli, L. Soares Piegas, D. Almeida, Z. M. Xu, G. Sidhu, R. A. Ahuad Guerrero, Z. Fan, U. K. Mahorkar, X. Tan, J. E. Isea Perez, T. Pradeep, S. M. Li, S. Zhou, P. J.C. Lujan, M. A. Hominal, A. D. Orlandini, R. Wang, S. A. Khan, N. Transk, Dorairaj Prabhakaran, Z. Hou, J. Pogue, Y. H. Liu, R. A. Peleteiro Mariño, K. N. Pradeep, John N. Nanas, A. Hamer, V. Mezzina, M. I. Genisans, P. Srinivas, E. Manenti, H. Singh, S. Adil, E. Ferro Queirel, N. Bender, D. Li, J. Cheng, Susmita Kaushik, J. Lou, R. K. Jain, J. Hiremath, V.K. Katyal, F. Zhao, Y. Jiang, Y. G. Zhang, N. Dadani, S. Thanikachalam, Khawar Kazmi, G. Yang, X. Tian, D. Barkavi, Ashok Kumar, X. Ma, W. J. Zhang, C. Shen, Q. L. Li, F. Li, W. Chen, A. Alves De Lima, B. Wang, D. Tian, T. N.C. Padmanabhan, M. B. Rao, A. Kalanidhi, K. Bhojomal, Lisheng Liu, G. D. Caime, N. G. Mohanarjun, B. R. Babu, F. Zhangfang, P. Bacher, L. Marano, S. Y. Liu, H. Xu, K. Ahmed, J. Narendra, Y. Xia, T. M. Jaison, G. Tognoni, X. Li, B. Yang, R. Calton, S. Sinha, A. R. Gonzalez Medina, S. Y. Yu, E. Paolasso, G. Qi, J. Muntaner, C. Z. Zhang, K. Jing, M. Ramesh, N. Cano Lopez, Rajnish Joshi, S. L. Liu, S. Balasubramaniyan, R. J. Balado, G. Deepak, Q. P. Wang, J. G. De Castro Amino, J. K. Chhaparwal, Q. Wang, X. Yang, L. Gong, Z. Zhang, Y. Kumble, A. Bharani, A. S.V.N. Rao, R. Corbalán Herreros, B. J. Kumar, G. Jacob, Y. Sun, S. Fu, Z. Xu, Z. C. Li, S. W. Wang, U. Raschke, D. Xavier, M. A. Brito, W. Liu, L. Li, G. Amuchastegui, S. Verma, W. Taylor, M. Rafiq, Jagdish, Mohammad Zubaid, J. Zhou, Sanjay Kalra, L. Yan, J. Carrillo Calvillo, I. Holadyk-Gris, S. R. Naik, Andrés Orlandini, T. X. Cui, H. Ozcoidi, Shweta Sharma, T. Chen, G. Covelli, Seemala Saikrishna Reddy, Y. Qin, D. H. Yan, G. Zapata, J. Lopez Ferre, A. Bozzano, R. Wadhwani, S. T. Chandy, J. Zhao, Rakesh Gupta, M. Gao, G. Xu, B. R. Malipeddi, A. Somani, A. Abdulminem, G. M. Font, K. Jeremaiah, K. G. Alexander, Jinhai Yang, C. Mata, H. R. Ramos, V. Vijan, Z. Zhen, Prashant P. Joshi, H. U. Banna, Z. C. Liu, O. A. Perrino, X. J. Bai, F. S. Zhou, J. O. Balbi, P. Papazoglou, H. Li, S. Dani, Z. Li, A. Nejrotti, H. G. Yang, R. Uchoa Azevedo, J. F. Shallam, Jack Hirsh, John Kanakakis, Rashid J. Ahmed, A. M. Faruqi, K. D. Rao, P. A. Jiwani, S. Borade, M. San Mauro, H. Chen, R. G. Salkar, X. Wang, P.P. Mohanan, A. Li, Anubhav Mittal, K. Zai, P. Guo, Carmen de la Cuesta, R. Nordaby, and Q. Meng
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Cardiogenic shock ,Percutaneous coronary intervention ,Context (language use) ,General Medicine ,Thrombolysis ,medicine.disease ,law.invention ,Reperfusion therapy ,Randomized controlled trial ,law ,Heart failure ,Internal medicine ,medicine ,Cardiology ,Myocardial infarction ,Medical emergency ,business - Abstract
Context Glucose-insulin-potassium (GIK) infusion is a widely applicable, low-cost therapy that has been postulated to improve mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Given the potential global importance of GIK infusion, a large, adequately powered randomized trial is required to determine the effect of GIK on mortality in patients with STEMI. Objective To determine the effect of high-dose GIK infusion on mortality in patients with STEMI. Design, setting, and participants Randomized controlled trial conducted in 470 centers worldwide among 20,201 patients with STEMI who presented within 12 hours of symptom onset. The mean age of patients was 58.6 years, and evidence-based therapies were commonly used. Intervention Patients were randomly assigned to receive GIK intravenous infusion for 24 hours plus usual care (n = 10,091) or to receive usual care alone (controls; n = 10,110). Main outcome measures Mortality, cardiac arrest, cardiogenic shock, and reinfarction at 30 days after randomization. Results At 30 days, 976 control patients (9.7%) and 1004 GIK infusion patients (10.0%) died (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.95-1.13; P = .45). There were no significant differences in the rates of cardiac arrest (1.5% [151/10 107] in control and 1.4% [139/10,088] in GIK infusion; HR, 0.93; 95% CI, 0.74-1.17; P = .51), cardiogenic shock (6.3% [640/10 107] vs 6.6% [667/10 088]; HR, 1.05; 95% CI, 0.94-1.17; P = .38), or reinfarction (2.4% [246/10,107] vs 2.3% [236/10,088]; HR, 0.98; 95% CI, 0.82-1.17; P = .81). The rates of heart failure at 7 days after randomization were also similar between the groups (16.9% [1711/10,107] vs 17.1% [1721/10,088]; HR, 1.01; 95% CI, 0.95-1.08; P = .72). The lack of benefit of GIK infusion on mortality was consistent in prespecified subgroups, including in those with and without diabetes, in those presenting with and without heart failure, in those presenting early and later after symptom onset, and in those receiving and not receiving reperfusion therapy (thrombolysis or primary percutaneous coronary intervention). Conclusion In this large, international randomized trial, high-dose GIK infusion had a neutral effect on mortality, cardiac arrest, and cardiogenic shock in patients with acute STEMI.
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- 2005
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