Coronary revascularization: A procedure in transition from on-pump to off-pump? The role of glucose-insulin-potassium revisited in a randomized, placebo-controlled study

Smith, Andrew; Grattan, Amanda; Harper, Mark; Royston, David; Riedel, Bernhard

doi:10.1053/jcan.2002.125151

Cited by 37 publications

(20 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3) changed significantly to 0.78 (95% CI 0.57 -1.07), with a heterogeneity of 0.53 ðP ¼0:91Þ: Two of the studies were published before 2002 [21,26] and on their exclusion the calculated OR for the incidence of AF changed to 0.67 (95% CI 0.54 -0.84), with a significant heterogeneity of 32.27 ðP ¼ 0:0007Þ: Three studies were of small size (, 50 patients in each group) [22,26,27] and exclusion of these from the analysis resulted in a calculated OR for incidence of AF of 0.70 (95% CI 0.56 -0.87), with a significant heterogeneity of 30.60 ðP ¼ 0:0007Þ:…”

Section: Sensitivity Analysis Resultsmentioning

confidence: 99%

“…Exclusion of these five studies from the analysis resulted in a calculated OR for incidence of AF of 0.81 (95% CI 0.63 -1.03), with heterogeneity of 9.67 ðP ¼ 0:29Þ: Similarly, cold blood cardioplegia was not used in four studies [21,22,29,30] and not reported in one study [33]. When we excluded these five studies from the analysis the calculated OR for incidence of AF changed to 0.59 (95% CI 0.41-0.83), with heterogeneity of 29.06 ðP ¼ 0:0003Þ: Retrograde cardioplegia was used in four studies [23,24,26,32,33] and was not reported in one [33].…”

Section: Sensitivity Analysis Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited

Athanasiou¹

2004

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most common post-operative complication in patients undergoing coronary artery bypass grafting, with an increased incidence associated with advancing age. This study aims to determine whether off-pump coronary artery bypass (OPCAB) reduces the incidence of AF in a generalized population (mean age <70 years). A meta-analysis was performed including all randomised and propensity score matched non-randomised studies published between 2001 and 2003 reporting a comparison between the two techniques in a generalised patient group (average age <70 years). The primary outcome of interest was post-operative AF. Sensitivity analysis was performed to evaluate consistency of the calculated treatment effect. Fourteen studies fulfilled our inclusion criteria, including a total of 16,505 subjects. The incidence of AF was 19% (1612/8265) in the off-pump group versus 24% (1976/8240) in the on-pump group. When considering only the 11 randomised studies (2207 subjects), we found a significant reduction in the incidence of post-operative AF in the off-pump group using a random-effect model (odds ratio (OR)=0.60, 95% confidence interval (CI)=0.45-0.82, and chi-square of heterogeneity=18.02, P=0.05). Sensitivity analysis highlighted one randomised study causing funnel plot asymmetry, exclusion of which resulted in a significant reduction in the incidence of post-operative AF in the off-pump group (OR=0.71, 95% CI=0.57-0.90), with a non-significant heterogeneity of 3.91 (P=0.92). When only studies of high quality were considered (898 patients), no significant difference was seen between on and off-pump groups (OR=0.78, 95% CI=0.57-1.07, and heterogeneity=0.53, P=0.91). This may be due to small number of patients in this group. Our results suggest that although OPCAB surgery may reduce the incidence of post-operative AF in a generalised population (age <70 years) this finding is not clearly supported by high quality randomised trials. Although previous evidence suggests that the incidence of post-operative AF is reduced in an elderly population (>70 years) with off-pump surgery, our results show that the evidence is less clear in a younger population group. The question of whether off-pump surgery in this patient group results in a lower rate of post-operative AF remains to be answered by further high quality randomised research.

show abstract

Section: Sensitivity Analysis Resultsmentioning

confidence: 99%

Section: Sensitivity Analysis Resultsmentioning

confidence: 99%

Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited

Athanasiou¹

2004

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…Twenty-five of the 38 studies report positive results with regard to GIK infusions [12,[16][17][18]21,26,[32][33][34][37][38][39]46,49,51,[53][54][55][56][57]59,[63][64][65][66][67], 11 studies report neutral or negative results [13,22,27,35,52,58,60,61,[68][69][70], and two studies [50,62] argue neither for nor against GIK infusions, as both studies were primarily not aimed at GIK effects but on other endpoints.…”

Section: Discussionmentioning

confidence: 99%

Forty years of glucose–insulin–potassium (GIK) in cardiac surgery: a review of randomized, controlled trials

Schipke

Friebe

Gams

2006

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Glucose-insulin-potassium (GIK) solutions have been used in cardiac surgery for more than 40 years. At that time, membrane-polarizing and stabilizing effects on cardiomyocyte's action potential were regarded the main benefit. Two meta-analyses described methodological flaws in the early studies (e.g., case numbers, randomization principles, and levels of significance), and came to clearly different recommendations with regard to the usage of GIK in the therapy of acute myocardial function. During the 70s, as promising therapies for the treatment of AMI had become available (e.g., beta-blockers and thrombolytic agents), the GIK technique was more widely introduced in cardiac surgery, e.g., during valve replacement. At present, 74 of 91 studies provide convincing evidence for the beneficial effects of insulin and/or GIK in cardiac surgery that go far beyond simple metabolic benefits and also include better recovery of myocardial tissue after ischemia. Yet, the exact underlying mechanisms remain still unknown. In this review article, two questions will be answered: why did GIK not become daily routine in cardiac surgery in spite of positive results from clinical studies, and does this technique merit more acceptance among the potential users? In view of the increasing number of older patients at higher risk, the demand for improving surgical procedures has renewed the interest in the GIK concept. The more recent literature suggests that the entire potential of GIK solutions has not been fully disclosed. A large single or multicenter trial with sound endpoints is mandatory.

show abstract

“…Perioperative trials were defined as those in which IIT was begun before, during, or immediately after surgery and was discontinued less than 24 h after surgery. No short-term mortality benefit was found, but mortality rates were low [51][52][53][54][55][56][57]. Some of the limitations of these studies were small sample sizes, low event rates, certain methodologic weaknesses, differences in interventions, and differences in blood glucose targets across trials [44••].…”

Section: Impact Of Glycemic Control and Clinical Outcomementioning

confidence: 99%

Management of Hyperglycemia During the Perioperative Period

Pichardo-Lowden

Gabbay

2011

Curr Diab Rep

View full text Add to dashboard Cite

Hyperglycemia is frequently encountered in the inpatient setting and is distinctly associated with poor clinical outcomes. Recent literature suggests an association between stringent glycemic control and increased mortality, thus keeping optimal glycemic targets a relevant subject of debate. In the surgical population, hyperglycemia with or without diabetes mellitus may be unrecognized. Factors contributing to hyperglycemia in the hospital include critical illness, use of certain drugs, use of enteral or parenteral nutrition, and variability in oral or nutritional intake as can occur when patients are prepared for procedures or surgery. A sensible approach to managing hyperglycemia in this population includes preoperative recognition of diabetes mellitus and risks for inpatient hyperglycemia. Judicious control of glycemia during the pre-, intra-, and postoperative time periods with avoidance of hypoglycemia mandates the need for a strategy for patient management that extend to time of discharge. We review the consequences of uncontrolled perioperative hyperglycemia, discuss current clinical guidelines and recent controversies, and provide practical tools for glycemic control in the surgical population.

show abstract

Coronary revascularization: A procedure in transition from on-pump to off-pump? The role of glucose-insulin-potassium revisited in a randomized, placebo-controlled study

Cited by 37 publications

References 39 publications

Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited

Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited

Forty years of glucose–insulin–potassium (GIK) in cardiac surgery: a review of randomized, controlled trials

Management of Hyperglycemia During the Perioperative Period

Contact Info

Product

Resources

About