Open Access Highly Accessed Research article

The impact of glucose-insulin-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction [ISRCTN56720616]

Iwan CC van der Horst12, Jan Paul Ottervanger2, Arnoud WJ van 't Hof2, Stoffer Reiffers3, Kor Miedema4, Jan CA Hoorntje2, Jan-Henk E Dambrink2, AT Marcel Gosselink2, Maarten WN Nijsten5, Harry Suryapranata2, Menko-Jan de Boer2 and Felix Zijlstra1*

Author Affiliations

1 Department of Cardiology, Thoraxcenter, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands

2 Department of Cardiology, Isala Klinieken, locatie Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands

3 Department of Nuclear Medicine, Isala Klinieken, locatie Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands

4 Department of Clinical Chemistry, Isala Klinieken, locatie Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands

5 Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands

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BMC Medicine 2005, 3:9  doi:10.1186/1741-7015-3-9

Published: 2 June 2005

Abstract

Background

Favorable clinical outcomes have been observed with glucose-insulin-potassium infusion (GIK) in acute myocardial infarction (MI). The mechanisms of this beneficial effect have not been delineated clearly. GIK has metabolic, anti-inflammatory and profibrinolytic effects and it may preserve the ischemic myocardium. We sought to assess the effect of GIK infusion on infarct size and left ventricular function, as part of a randomized controlled trial.

Methods

Patients (n = 940) treated for acute MI by primary percutaneous coronary intervention (PCI) were randomized to GIK infusion or no infusion. Endpoints were the creatinine kinase MB-fraction (CK-MB) and left ventricular ejection fraction (LVEF). CK-MB levels were determined 0, 2, 4, 6, 24, 48, 72 and 96 hours after admission and the LVEF was measured before discharge.

Results

There were no differences between the two groups in the time course or magnitude of CK-MB release: the peak CK-MB level was 249 ± 228 U/L in the GIK group and 240 ± 200 U/L in the control group (NS). The mean LVEF was 43.7 ± 11.0 % in the GIK group and 42.4 ± 11.7% in the control group (P = 0.12). A LVEF ≤ 30% was observed in 18% in the controls and in 12% of the GIK group (P = 0.01).

Conclusion

Treatment with GIK has no effect on myocardial function as determined by LVEF and by the pattern or magnitude of enzyme release. However, left ventricular function was preserved in GIK treated patients.