Glucose-insulin-potassium

Glucose insulin potassium (GIK) infusion has been suggested by some to offer additional myocardial salvage in the setting of an acute Ml. Theoretically, GIK infusion provides glycolytic fuel to both the starving ischemic myocardium before intervention and the reperfused myocardium after PCI. It is also thought to decrease free fatty acid (FFA) levels and toxic FFA uptake by the ischemic myocardium. 

Fath-Ordoubadi p Beatt KJ. Glucose-insulin-potassium therapy for treatment of acute myocardial infarction an overview of randomized placebo-controlled trials. Circulation 1997 96 1 152-1 156. 

Ceremuzynski L, Budaj A, Czepiel A, et al. Low-dose glucose-insulin-potassium is ineffective in acute myocardial infarction results of a randomized multicenter Pol-GIK trial. Cardiovasc Drugs Ther 1999 13 191-200. 

S. Gradinac, G.M. Coleman, H. Taegtmeyer, M.S. Sweeney and O.H. Frazier, Improved cardiac function with glucose-insulin-potassium after aortocoronary bypass grafting, Ann. Thorac. Surg. 48(4), 484-489 (1989). 

A.K. Jonassen, E. Aasum, R.A. Riemersma, O.D. Mjos and T.S. Larsen, Glucose-insulin-potassium reduces infarct size when administered during reperfusion, Cardiovasc. Drugs Ther. 14, 615-623 (2000). 

H.F. Zhang, Q. Fan, X.X. Qian, B.L. Lopez, T.A. Christopher, X.L. Ma and F. Gao, Role of insulin in the antiapoptotic effect of glucose-insulin-potassium in rabbits with acute myocardial ischemia and reperfusion. Apoptosis 9, 777-783 (2004). 

GIK, glucose-insulin-potassium solution AMI, acute myocardial infarction PTCA, percutaneous transluminal coronary angioplasty CABG, coronary artery bypass graft cariporide and enaporide are sodium/proton exchanger inhibitors N-acetyl-cysteine is an anti-oxidant agent. 

S.R. Mehta, S. Yusuf, R. Diaz, J. Zhu, P. Pais, D. Xavier, E. Paolasso, R. Ahmed, C. Xie, K. Kazmi, J. Tai, A. Orlandini, J. Pogue, L. Liu 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. 293(4), 437-446 (2005). 

Recent pharmacological therapies that have shown promise in clinical trials include adenosine, pexelizumab, and glucose-insulin-potassium (GIK). In the AMISTAD-2 trial, patients treated with high-dose adenosine had a smaller infarct size (11% vs. 26% p = 0.03) (77). The COMMA trial evaluated the effect of pexelizumab, a novel C5 complement inhibitor, to reduce reperfusion injury (78). Although there was no difference in infarct size between study groups, there was a surprising mortality benefit in patients treated with pexelizumab bolus... 

A large array of agents has been tested for metabolic protection of the myocardium, but most have been discarded either after proving ineffective in clinical trials or protective in only a limited subset of STEMI patients. Some interest in glucose-insulin-potassium (GIK) continues to exist, but it is likely that the volume load associated with its administration will limit GIK to patients without significant pump dysfunction (76). 

Apstein CS. The benefits of glucose-insulin-potassium for acute myocardial infarction (and some concerns). J Am Coll Cardiol. 2003 42 792-795. 

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