BACKGROUND: Recent randomised clinical trials have not confirmed the beneficial effects of glucose-insulin-potassium (GIK) infusion observed in experimental models of myocardial ischaemia and infarction. METHODS: We investigated glucose levels and insulin dose in 107 patients treated with reperfusion therapy and GIK for acute myocardial infarction. RESULTS: Despite high insulin infusion rates, persistent hyperglycaemia occurred in 37% of the patients. These patients had significantly larger infarctions, as measured by enzyme release (p=0.006). In a multivariate model predicting high troponin levels, refractory hyperglycaemia remained a significant parameter (p=0.02). CONCLUSION: These findings suggest that refractory hyperglycaemia caused by high-dose glucose infusion may, at least in part, explain the discrepancy between the experimental and clinical data.
BACKGROUND: Recent randomised clinical trials have not confirmed the beneficial effects of glucose-insulin-potassium (GIK) infusion observed in experimental models of myocardial ischaemia and infarction. METHODS: We investigated glucose levels and insulin dose in 107 patients treated with reperfusion therapy and GIK for acute myocardial infarction. RESULTS: Despite high insulin infusion rates, persistent hyperglycaemia occurred in 37% of the patients. These patients had significantly larger infarctions, as measured by enzyme release (p=0.006). In a multivariate model predicting high troponin levels, refractory hyperglycaemia remained a significant parameter (p=0.02). CONCLUSION: These findings suggest that refractory hyperglycaemia caused by high-dose glucose infusion may, at least in part, explain the discrepancy between the experimental and clinical data.
Authors: G van den Berghe; P Wouters; F Weekers; C Verwaest; F Bruyninckx; M Schetz; D Vlasselaers; P Ferdinande; P Lauwers; R Bouillon Journal: N Engl J Med Date: 2001-11-08 Impact factor: 91.245
Authors: Iwan C C van der Horst; Felix Zijlstra; Arnoud W J van 't Hof; Carine J M Doggen; Menko-Jan de Boer; Harry Suryapranata; Jan C A Hoorntje; Jan-Henk E Dambrink; Rijk O B Gans; Henk J G Bilo Journal: J Am Coll Cardiol Date: 2003-09-03 Impact factor: 24.094
Authors: Anouk M Corstjens; Iwan C C van der Horst; Jan G Zijlstra; A B Johan Groeneveld; Felix Zijlstra; Jaap E Tulleken; Jack J M Ligtenberg Journal: Crit Care Date: 2006-06-27 Impact factor: 9.097