Emergency GIK solution does not reduce progression to heart attack
MedWire News: Out-of-hospital administration of an intravenous glucose-insulin-potassium (GIK) solution to patients with suspected acute coronary syndromes does not reduce their progression to myocardial infarction (MI), say researchers.
However, GIK solution was associated with a significantly lower rate of the composite endpoint of cardiac arrest or in-hospital death, write Harry Selker (Tufts Medical Center, Boston, Massachusetts, USA) and co-workers.
The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency Care (IMMEDIATE) trial, which was published in the Journal of the American Medical Association to coincide with its presentation at the American College of Cardiology's 61st annual scientific sessions, was conducted across 36 emergency medical service agencies from December 2006 through July 2011.
For the trial, paramedics used electrocardiograph (ECG)-based decision support to randomly allocate 971 patients who had a high probability of ACS to receive either intravenous GIK solution containing 30% glucose (300 g/L), 50 U/L regular insulin, and 80 mEq of KCl/L (n=411) or identical-appearing 5% glucose placebo (n=460). Both solutions were administered by paramedics in the out-of-hospital setting and continued for 12 hours.
There was no significant difference in the rate of progression of ACS to MI within 24 hours, as assessed by biomarkers and ECG evidence, between those who received GIK and those who received placebo.
Thirty-day mortality also did not differ significantly between GIK patients and those who received placebo.
The composite of cardiac arrest or in-hospital mortality occurred in 4.4% of patients given GIK versus 8.7% of those given placebo, corresponding to an odds ratio of 0.48.
Among patients with ST-segment elevation on their initial out-of-hospital ECG, (n=163 GIK and 194 placebo), progression to MI was 85.3% versus 88.7% and 30-day mortality was 4.9% versus 7.7% in GIK versus placebo patients.
The composite outcome of cardiac arrest or in-hospital mortality was met by 6.1% of GIK-treated patients versus 14.4% of those given placebo.
"Compared with placebo, GIK administration was not associated with improvement in 30-day survival but was associated with lower rates of the composite outcomes of cardiac arrest or in-hospital mortality," say the authors.
"Further studies are needed to assess the out-of-hospital use of GIK as therapy for patients with ACS," they conclude.
By Piriya Mahendra