No drop in progression to MI for patients treated immediately with glucose, insulin, potassium
TUESDAY, March 27 (HealthDay News) -- For patients with suspected acute coronary syndromes (ACS), immediate administration of glucose-insulin-potassium (GIK) is not associated with a reduction in the progression to myocardial infarction (MI), according to a study published online March 27 in the Journal of the American Medical Association to coincide with presentation at the annual meeting of the American College of Cardiology, held from March 24 to 27 in Chicago.
Harry P. Selker, M.D., M.S.P.H., from Tufts Medical Center in Boston, and colleagues investigated out-of hospital emergency medical service administration of GIK within the first hours of a suspected ACS. Paramedics, assisted by electrocardiograph (ECG)-based decision support, randomly allocated 911 patients (871 enrolled) with high probability of ACS to receive either intravenous GIK solution (411 patients) or 5 percent glucose placebo solution (460 patients).
The researchers observed no significant difference in the rate of progression to MI in patients who received GIK compared with those who received placebo (48.7 and 52.6 percent, respectively; odds ratio [OR], 0.88; P = 0.28). Thirty-day mortality was also similar among those who received GIK and those who received placebo (4.4 and 6.1 percent, respectively; hazard ratio, 0.72; P = 0.27). The composite of cardiac arrest or in-hospital mortality was seen in significantly fewer patients who received GIK (4.4 versus 8.7 percent; OR, 0.48; P = 0.01). The results for progression to MI were similar among a subgroup of patients presenting with ST-segment elevation.
"Among patients with suspected ACS, out-of-hospital administration of intravenous GIK, compared with glucose placebo, did not reduce progression to MI," the authors write.
Several authors disclosed financial ties to the medical device and health care industries. Insulin was provided by Eli Lilly and ECG-based decision support software was donated by Physio-Control and Zoll Medical.