Clinical effects of glucose-insulin-potassium on left ventricular function in acute myocardial infarction: Results from a randomized clinical trial

Academic Article

Abstract

  • The effects of glucose-insulin-potassium (GIK) on hemodynamics and left ventricular (LV) function in patients with acute myocardial infarction (AMI) were investigated in a prospective randomized study. Patients who presented with suspected AMI were candidates for this study if prerandomization evaluation was completed within 12 hours from onset of chest pain. Patients over 75 years of age, insulin-dependent diabetics, patients with renal insufficlency, and comatose patients were excluded. Following completion of baseline hemodynamic measurements, patients were randomly allocated to 48-hour infusion of 300 gm G, 500 units I, and 80 mEq KCl per liter at rate of 1.5 ml/kg/hr or to conventional therapy. In addition to serial hemodynamic measurements, dextran LV function curves (LVFC) were constructed during the second and third days to assess extent of LV injury. Eighty-five of 118 patients who were initially randomized into this study had AMI documented by diagnostic rise and fall of CK-MB isoenzyme. Baseline characteristics and hemodynamics were similar for GIK and control patients with AMI. GIK patients who presented with their initial AMI had significant reduction in pulmonary arterial end-diastolic pressure from prerandomization value of 16 ± 1 to 10 ± 1 by day 3, compared to 18 ± 1 to 16 ± 1 mm Hg for control patients (p < 0.001), and increase in cardiac index (Cl) from 2.8 ± 0.1 to 3.4 ± 0.1 versus 2.8 ± 0.1 to 3.0 ± 0.1 L/min/m for control patients (p < 0.05). In response to dextran infusion. GIK patients had significant further increase in Cl to 3.9 ± 0.3 (p < 0.001) and an ascending siope to their LVFC (p < 0.05) compared to no significant change in Cl (3.2 ± 0.2) and a flat curve for control patients. These data demonstrate that acute intervention with GIK compared to control improves hemodynamics and LV function in AMI patients beyond the infusion period by preserving ischemic myocardium. © 1981. 2
  • Authors

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    Digital Object Identifier (doi)

    Author List

  • Mantle JA; Rogers WJ; Smith LR; McDaniel HG; Papapietro SE; Russell RO; Rackley CE
  • Start Page

  • 313
  • End Page

  • 324
  • Volume

  • 102
  • Issue

  • 3 PART 1