Effect of Glucose-Insulin-Potassium on Heart Function of Patients with Acute Myocardial Infarction: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Zhaohui ¹² ,  YANG Kehu ² , MA Bin ² , YIN Shaofu ¹

1 School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China2 Evidence-Based Medicine Center, Lanzhou University, Lanzhou 730000, China;

Corresponding author：

YANG Kehu, Email: summitmna@163.com

Keywords：

Glucose-insulin-potassium; Myocardial infarction; Heart function; Randomized controlled trial; Systematic Review

DOI：

10.7507/1672-2531.20080025

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the efficacy of glucose-insul in-potassium (GIK) in patients with acute myocardialinfarction　(AMI).
Methods 　Both foreign language databases including The Cochrane Library (issue 4, 2007), PubMed, EMBASE and Chinese databases involving CBM, VIP and CJFD were searched to identify randomized controlled trials (RCTs) that reported the effect of GIK on the heart function (left ventricular ejection fraction LVEF, ST changes, left ventricular remodel ing) of patients with AMI. Two reviewers assessed the qual ity of each trial and extracted data independently. The Cochrane Collaboration’s RevMan 4.2.10 software was used for statistical analysis.
Results 　Five RCTs were included, all of which came from abroad. The methodological qual ity of the included studies was good. The basel ine data of each trial were comparable. Meta-analyses showed that no significant difference was observed in the improvement of LVEF between the GIK group and the control group (WMD=1.87, 95%CI -0.32 to 4.06, P =0.09), whereas GIK was more beneficial in decreasing ST (OR=1.92, 95%CI 1.25 to 2.96,P =0.003) and preventing left ventricular remodel ing (OR=0.08, 95%CI 0.01 to 0.68, P=0.02).
Conclusion 　Based on the above evidence, although GIK may, to some extent, be beneficial for both ST decreasing and long-term prognoses in patients with AMI, it can not yet be concluded that GIK can improve the heart function of those patients. Therefore, it is imperative to design and implement further stricter, large-scale RCTs, so as to accurately identify the therapeutic effect of GIK solution in patients with myocardial infarction.

Citation： YANG Zhaohui,YANG Kehu,MA Bin,YIN Shaofu. Effect of Glucose-Insulin-Potassium on Heart Function of Patients with Acute Myocardial Infarction: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(2): 97-101. doi: 10.7507/1672-2531.20080025 Copy

1.	高润霖. 急性心肌梗死诊断和治疗指南.中华心血管病杂志, 2001, 29(12): 711.
2.	Nicolas Danchin, Edoardo De Benedetti, Phil ip Urban. Treatment of acute myocardial infarction. Clinical Evidence, 2003, (9):23-4. 葛宁, 译. 中国循证医学杂志, 2004, 4(6): 426.
3.	Zeymer U,Neuhaus KL.Thrombolys is and percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction. Z Kardiol, 2000, 89 Suppl 4: IV30-40.
4.	Sodi-Pallares D, Testell i MR, Fischelder BL,et al. Effects of an intravenous infusion of potassium-glucose-insul in solution on the electrocardiographic signs of myocardial infarction. Am J Cardiol, 1962, 9: 166–181.
5.	Bucciarell i-Ducci C, Bianchi M, De Luca L, et al. Effects of glucose-insulin-potassium infusion on myocardial perfusion and left ventricular remodel ing in patients treated with primary angioplasty for ST-elevation acute myocardial infarction. Am J Cardiol, 2006, 98(10): 1349-1353.
6.	Krljanac G, Vasiljevic Z, Radovanovic M, et al. Effects of glucose-insulin-potassium infusion on ST-elevation myocardial infarction in patients treated with thrombolytic therapy. Am J Cardiol, 2005, 96(8): 1053-1058.
7.	Van der Horst IC, De Luca G, Ottervanger JP, et al. ST-segment elevation resolution and outcome in patients treated with primary angioplasty and glucose-insulin-potassium infusion. Am Heart J, 2005, 149(6): 1135.
8.	Van der Horst IC, Ottervanger JP, van ‘t Hof AW, et al. The impact of glucose-insul in-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction. BMC Med, 2005, 3: 9.
9.	Castro PF, Larrain G, Baeza R,et al. Effects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty. Crit Care Med, 2003, 31(8): 2152-2155.
10.	Zhu P, Lu L, Xu Y,et al. Glucose-insulin-potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs. Am J Physiol Heart Circ Physiol, 2000, 278: H595-603.
11.	Jonassen AK, Aasum E, Riemersma RA,et al. Glucose-insulin-potassium reduces infarct size when administered during reperfusion. Cardiovasc Drugs Ther, 2000, 14: 615-623.
12.	Addo TA, Keeley EC, Cigarroa JE, et al. Effect of glucose-insulin-potassium infusion on plasma free fatty acid concentrations in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiol, 2004, 94(10): 1288-1289.
13.	Opie LH, Tansey M, Kennelly BM. Proposed metabolic vicious circle in patients with large myocardial infaRCT and high plasma-free-fatty-acid concentrations. Lancet, 1977, 2: 890–892.
14.	Oliver MF, Kurien VA, Greenwood TW. Relation between serum-free-fatty acids and arrhythmias and death after acute myocardial infarction. Lancet, 1968, 1: 710 –714.
15.	Mehta SR, Yusuf S, Diaz R,et al. CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction:the CREATE-ECLA randomized controlled trial. JAMA, 2005, 293(4): 437-446.
16.	Diaz R, Paolasso EA, Piegas LS,et al. Metabol ic modulation of acute myocardial infarction. The ECLA(Estudios Cardiologicos Latinoamerica) Collaborative Group.Circulation,1998,98: 2227-2234.
17.	Van der Horst IC, Zijlstra F, van’t Hof AW, et al. Glucose-insulin-potassium infusion in patients treated with primary angioplasty for acute myocardial infarction:the Glucose-Insulin-Potassium Study: a randomized trial. J Am Coll Cardiol, 2003, 42: 784 -791.
18.	Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol, 1995, 26: 57- 65.
19.	Carl S. Apstein1 and Lionel H. Opie. A challenge to the metabolic approach to myocardial ischaemia. Eur Heart J, 2005, 26(10): 956-959.

1. 高润霖. 急性心肌梗死诊断和治疗指南.中华心血管病杂志, 2001, 29(12): 711.
2. Nicolas Danchin, Edoardo De Benedetti, Phil ip Urban. Treatment of acute myocardial infarction. Clinical Evidence, 2003, (9):23-4. 葛宁, 译. 中国循证医学杂志, 2004, 4(6): 426.
3. Zeymer U,Neuhaus KL.Thrombolys is and percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction. Z Kardiol, 2000, 89 Suppl 4: IV30-40.
4. Sodi-Pallares D, Testell i MR, Fischelder BL,et al. Effects of an intravenous infusion of potassium-glucose-insul in solution on the electrocardiographic signs of myocardial infarction. Am J Cardiol, 1962, 9: 166–181.
5. Bucciarell i-Ducci C, Bianchi M, De Luca L, et al. Effects of glucose-insulin-potassium infusion on myocardial perfusion and left ventricular remodel ing in patients treated with primary angioplasty for ST-elevation acute myocardial infarction. Am J Cardiol, 2006, 98(10): 1349-1353.
6. Krljanac G, Vasiljevic Z, Radovanovic M, et al. Effects of glucose-insulin-potassium infusion on ST-elevation myocardial infarction in patients treated with thrombolytic therapy. Am J Cardiol, 2005, 96(8): 1053-1058.
7. Van der Horst IC, De Luca G, Ottervanger JP, et al. ST-segment elevation resolution and outcome in patients treated with primary angioplasty and glucose-insulin-potassium infusion. Am Heart J, 2005, 149(6): 1135.
8. Van der Horst IC, Ottervanger JP, van ‘t Hof AW, et al. The impact of glucose-insul in-potassium infusion in acute myocardial infarction on infarct size and left ventricular ejection fraction. BMC Med, 2005, 3: 9.
9. Castro PF, Larrain G, Baeza R,et al. Effects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty. Crit Care Med, 2003, 31(8): 2152-2155.
10. Zhu P, Lu L, Xu Y,et al. Glucose-insulin-potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs. Am J Physiol Heart Circ Physiol, 2000, 278: H595-603.
11. Jonassen AK, Aasum E, Riemersma RA,et al. Glucose-insulin-potassium reduces infarct size when administered during reperfusion. Cardiovasc Drugs Ther, 2000, 14: 615-623.
12. Addo TA, Keeley EC, Cigarroa JE, et al. Effect of glucose-insulin-potassium infusion on plasma free fatty acid concentrations in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiol, 2004, 94(10): 1288-1289.
13. Opie LH, Tansey M, Kennelly BM. Proposed metabolic vicious circle in patients with large myocardial infaRCT and high plasma-free-fatty-acid concentrations. Lancet, 1977, 2: 890–892.
14. Oliver MF, Kurien VA, Greenwood TW. Relation between serum-free-fatty acids and arrhythmias and death after acute myocardial infarction. Lancet, 1968, 1: 710 –714.
15. Mehta SR, Yusuf S, Diaz R,et al. CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction:the CREATE-ECLA randomized controlled trial. JAMA, 2005, 293(4): 437-446.
16. Diaz R, Paolasso EA, Piegas LS,et al. Metabol ic modulation of acute myocardial infarction. The ECLA(Estudios Cardiologicos Latinoamerica) Collaborative Group.Circulation,1998,98: 2227-2234.
17. Van der Horst IC, Zijlstra F, van’t Hof AW, et al. Glucose-insulin-potassium infusion in patients treated with primary angioplasty for acute myocardial infarction:the Glucose-Insulin-Potassium Study: a randomized trial. J Am Coll Cardiol, 2003, 42: 784 -791.
18. Malmberg K, Ryden L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol, 1995, 26: 57- 65.
19. Carl S. Apstein1 and Lionel H. Opie. A challenge to the metabolic approach to myocardial ischaemia. Eur Heart J, 2005, 26(10): 956-959.

Chinese Journal of Evidence-Based Medicine

Effect of Glucose-Insulin-Potassium on Heart Function of Patients with Acute Myocardial Infarction: A Systematic Review

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