Metabolic Modulation of Acute Myocardial Infarction

Abstract

on behalf of the ECLA (Estudios Cardiológicos Latinoamérica) Collaborative Group* Background-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. Methods and Results-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; 2Pϭ0.008) and a consistent trend toward fewer in-hospital events in the GIK group were observed. Conclusions-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.

Signal transducer and activator of transcription 3 is involved in the cardioprotective signalling pathway activated by insulin therapy at reperfusion

“…To confer its cardioprotection, insulin needs to be given at least during the first 15 min of reperfusion in an isolated rat heart model where it activates PI3K signalling pathways [19][20][21]. Insulin may also reduce mortality as suggested by a retrospective analysis of patients with acute myocardial infarction undergoing reperfusion therapy [9]. Using insulin infusions in the same dosage range as in the isolated heart and cardiomycocyte experiments to protect the ischemic myocardium upon reperfusion would constitute a safe and cheap technique.…”

A new look at the heart in diabetes mellitus: from ailing to failing

“…In the ECLA pilot trial, which assessed the effect of a glucose-insulin-potassium-infusion in patients with acute myocardial infarction, a non-significant reduction in hospital events in patients allocated to glucose-insulin-potassium-infusion and a reduction in mortality in patients additionally treated with reperfusion strategies was observed [152].…”

Effects of Glucagon-Like Peptide-1 in Patients With Acute Myocardial Infarction and Left Ventricular Dysfunction After Successful Reperfusion

“…G lucose-insulin-potassium (GIK) infusions have been used as metabolic adjuvants in acute myocardial infarction (AMI) [1][2][3][4][5] in an attempt to enhance myocardial glucose uptake and oxidation and take advantage of the efficacy of this substrate in generating ATP. 6,7 Recently, a group of Dutch investigators 8 reported beneficial effects of GIK therapy in patients with AMI treated with percutaneous coronary intervention (PCI).…”