Abstract
Objective:To evaluate the effects of high-dose glucose–insulin–potassium (GIK) solution on hemodynamics and cardiac remodeling in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).Patients and Methods:We observed the changes in the hemodynamic parameters in 26 patients with AMI. All patients received primary PCI before entering the study. All patients in the study were randomized into the GIK group (n = 14) or the control group (n = 12). Patients in the GIK group received high-dose GIK solution (25% glucose, 80 mmol/L KCl and 50 IU/L insulin; 1.5 ml/kg/h) over 24 h. Patients in the control group received standard therapy. We monitored the hemodynamic parameters at baseline and after 6 h, 12 h, 18 h and 24 h, respectively. Then, we followed-up the cardiac function with echocardiography after 7 days, 1 month and 6 months.Results:The basic clinical data was similar between the groups. Primary PCI was performed successfully in 25 patients. The two groups were indistinguishable in all factors measured. GIK solution did not have a deleterious effect on the hemodynamic parameters. The pulmonary capillary wedge pressure increased during the first 12-h period and then decreased smoothly (F = 3.75, P = 0.02). The trends were similar between the two groups. The system vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI) decreased during the first 12 h in the GIK group but increased in the control group. The GIK solution significantly influenced SVRI (F = 4.71, P = 0.02). GIK solution improved the cardiac function measured by stroke volume (F = 4.11, P = 0.03) and cardiac index (F = 4.40, P = 0.02). In the 6-month follow-up, GIK improved cardiac remodeling (left ventricular diastolic diameter: 49.2 ± 2.89 vs. 53.9 ± 2.48, P < 0.001; left ventricular systolic diameter: 32.9 ± 2.24 vs. 35.9 ± 2.78, P < 0.01).Conclusion:High-dose GIK solution had no adverse effects on the hemodynamics in AMI patients treated with primary PCI. It can improve cardiac function by lowering SVRI. In the 6-month follow-up, it improved cardiac remodeling.
Highlights
The concept that the metabolic cocktail, glucose–insulin– potassium (GIK), may protect ischemic cardiomyocytes was first popularized by Sodi-Pallares as a “polarizing agent” in 1962.[1]
Our study has clearly shown that early after acute myocardial infarction (AMI), highdose GIK infusion improves cardiac function, as judged by hemodynamic measurements
Our previous study had shown that high-dose GIK can decrease the cardiomyocyte apoptosis in AMI patients with reperfusion therapy.[16]
Summary
The concept that the metabolic cocktail, glucose–insulin– potassium (GIK), may protect ischemic cardiomyocytes was first popularized by Sodi-Pallares as a “polarizing agent” in 1962.[1]. The purpose of the present study is to analyze the hemodynamic changes during the first 24 h after intravenous administration of high-dose GIK solution in patients with a ST-segment elevated AMI who have received primary PCI. If the patient was randomized into the GIK group, GIK solution was given by an infusion of 1.5 ml/kg/h over 24 h after baseline hemodynamic measurement obtained. The speed of the GIK infusion was not adjusted before the serum concentration of glucose and potassium were obtained. When the serum glucose concentration was between 250 mg/dl and 350 mg/dl before or during the intravenous administration, it was considered to be down-regulated and the patients were administered extra insulin by means of intravenous or hypodermal routes rather than adjusting the GIK infusion. The levels of serum cTnI were analyzed using the OPUS instrument
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