Published on:
    Journal of Cardiovascular Disease Research, 2010; 1(3):104--109
    Original Article | doi:10.4103/0975-3583.70899

    High-dose glucose–insulin–potassium has hemodynamic benefits and can improve cardiac remodeling in acute myocardial infarction treated with primary percutaneous coronary intervention: From a randomized controlled study

    Authors:

    Yanhui Li, Lin Zhang, Lei Zhang, Haiyong Zhang, Nianzhong Zhang, Zhongsu Yang, Mingming Gao, Xinchun Yang, Liang Cui

    Heart Center, Beijing Chaoyang Hospital and Institute of Cardiovascular Disease, Capital Medical University, Beijing - 100020, P. R. China.

    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 fi rst 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 fi rst 12 h in the GIK group but increased in the control group. The GIK solution signifi cantly infl uenced 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.

    Key words: Acute myocardial infarction, glucose–insulin–potassium, reperfusion therapy.