Pache Jürgen, Kastrati Adnan, Mehilli Julinda, Bollwein Hildegard, Ndrepepa Gjin, Schühlen Helmut, Martinoff Stefan, Seyfarth Melchior, Nekolla Stephan, Dirschinger Josef, Schwaiger Markus, Schömig Albert
Medizinische Klinik rechts der Isar, Munich, Germany.
Am Heart J. 2004 Jul;148(1):e3. doi: 10.1016/j.ahj.2004.01.019.
Intravenous glucose-insulin-potassium (GIK) may have a positive metabolic influence in patients with acute myocardial infarction (AMI) who receive reperfusion therapy. The objective of this randomized trial was to assess for the first time whether GIK improves myocardial salvage in patients with AMI.
The Reevaluation of Intensified Venous Metabolic Support for Acute Infarct Size Limitation (REVIVAL) trial is a randomized, open-label study conducted among 312 patients with AMI. Patients were randomly assigned to either the GIK therapy group (n = 155) or the control group (n = 157). All patients were intended to receive reperfusion treatment, which was given in all but 5 patients (1.6%). The primary end point of the study was salvage index, measured as the proportion of initial perfusion defect (acute technetium-99m sestamibi scintigraphy) salvaged by therapy (follow-up scintigraphy performed after 7 to 14 days).
The primary end point of the study, the salvage index, was in median 0.50 (25th, 75th percentiles: 0.18, 0.87) in the GIK group and 0.48 (25th, 75th percentiles: 0.27, 0.78) in the control group (P =.96). By 6 months, the mortality rate was 5.8% in the GIK group and 6.4% in the control group (P =.85; relative risk, 0.92; 95% CI, 0.37 to 2.26). Subgroup analyses showed that GIK therapy was associated with increased salvage index only among diabetic patients (mean difference, 0.19; 95% CI, 0.01 to 0.37).
The routine use of GIK therapy in patients with AMI is not associated with enhanced myocardial salvage. This therapy appears to improve myocardial salvage only among diabetic patients.
静脉输注葡萄糖-胰岛素-钾（GIK）可能对接受再灌注治疗的急性心肌梗死（AMI）患者产生积极的代谢影响。这项随机试验的目的是首次评估GIK是否能改善AMI患者的心肌挽救情况。
急性梗死面积限制强化静脉代谢支持再评估（REVIVAL）试验是一项针对312例AMI患者进行的随机、开放标签研究。患者被随机分配至GIK治疗组（n = 155）或对照组（n = 157）。所有患者均计划接受再灌注治疗，除5例患者（1.6%）外均接受了该治疗。研究的主要终点是挽救指数，通过治疗挽救的初始灌注缺损（急性锝-99m 甲氧基异丁基异腈闪烁显像）比例来衡量（7至14天后进行随访闪烁显像）。
研究的主要终点挽救指数在GIK组中位数为0.50（第25、75百分位数：0.18，0.87），在对照组中位数为0.48（第25、75百分位数：0.27，0.78）（P = 0.96）。到6个月时，GIK组死亡率为5.8%，对照组为6.4%（P = 0.85；相对危险度，0.92；95%可信区间，0.37至2.26）。亚组分析显示，GIK治疗仅在糖尿病患者中与挽救指数增加相关（平均差异，0.19；95%可信区间，0.01至0.37）。
AMI患者常规使用GIK治疗与增强心肌挽救无关。这种治疗似乎仅在糖尿病患者中能改善心肌挽救情况。
