Díaz R, Paolasso E A, Piegas L S, Tajer C D, Moreno M G, Corvalán R, Isea J E, Romero G
Department of Cardiology, Instituto Cardiovascular de Rosario, Rosario, Argentina.
Circulation. 1998 Nov 24;98(21):2227-34. doi: 10.1161/01.cir.98.21.2227.
Several trials have been performed in the past using glucose, insulin, and potassium infusion (GIK) for the treatment of acute myocardial infarction (AMI). Because of continuing uncertainty about the potential role of this therapeutic intervention, we conducted a randomized trial to evaluate the impact of a GIK solution during the first hours of AMI.
Four hundred seven patients with suspected AMI admitted within 24 hours of symptoms onset were enrolled. In a ratio of 2:1, 268 patients were allocated to receive GIK (high- or low-dose) and 139 to receive control. Phlebitis and serum changes in the plasma concentration of glucose or potassium were observed more often with GIK. A trend toward a nonsignificant reduction in major and minor in-hospital events was observed in patients allocated to GIK. In 252 patients (61.9%) treated with reperfusion strategies, a statistically significant reduction in mortality (relative risk [RR] 0.34; 95% CI: 0.15 to 0.78; 2P=0.008) and a consistent trend toward fewer in-hospital events in the GIK group were observed.
Our results confirm that a metabolic modulation strategy in the first hours of an AMI is feasible, applicable worldwide, and has mild side effects. The statistically significant mortality reduction in patients who underwent a reperfusion strategy might have important implications for the management of AMI patients. It is now essential to perform a large-scale trial to reliably determine the magnitude of benefit.
过去曾进行过几项使用葡萄糖、胰岛素和钾输注（GIK）治疗急性心肌梗死（AMI）的试验。由于这种治疗干预的潜在作用仍存在不确定性，我们进行了一项随机试验，以评估GIK溶液在AMI发病后最初几小时内的影响。
纳入了407例症状发作后24小时内入院的疑似AMI患者。按照2:1的比例，268例患者被分配接受GIK（高剂量或低剂量）治疗，139例接受对照治疗。GIK组更常观察到静脉炎以及血浆葡萄糖或钾浓度的血清变化。在接受GIK治疗的患者中，观察到主要和次要院内事件有非显著减少的趋势。在252例（61.9%）接受再灌注策略治疗的患者中，GIK组的死亡率有统计学显著降低（相对风险[RR]0.34；95%置信区间：0.15至0.78；P=0.008），且院内事件有持续减少的趋势。
我们的结果证实，在AMI发病后的最初几小时内采用代谢调节策略是可行的，适用于全球，且副作用轻微。接受再灌注策略治疗的患者死亡率有统计学显著降低，这可能对AMI患者的管理具有重要意义。现在进行大规模试验以可靠确定获益程度至关重要。
