Key result
Intensive glucose-lowering therapy can improve survival in acute myocardial infarction, but systematic glucose-insulin-potassium infusion lacks benefit in the reperfusion era and has been abandoned.
Why the study?
Does intensive glucose-lowering therapy with insulin or glucose-insulin-potassium infusion improve mortality in patients with acute coronary syndrome?
Systematic Review
Does intensive glucose-lowering therapy with insulin or glucose-insulin-potassium infusion improve mortality in patients with acute coronary syndrome?
Routine use of glucose-insulin-potassium infusion is not beneficial in ACS, and while intensive insulin therapy may improve outcomes, its clinical utility is limited by the risk of hypoglycemia and difficulty in maintaining target glucose levels.
Avoid GIK in ACS; confirms its abandonment while leaving safer intensive glucose strategies open to further trials.
Patients with acute myocardial infarction (AMI) and diabetes mellitus, as well as patients admitted with elevated blood glucose without known diabetes, have impaired outcome. Therefore intensive glucose-lowering therapy with insulin (IGL) has been proposed in diabetic or hyperglycaemic patients and has been shown to improve survival and reduce incidence of adverse events. The current manuscript provides an overview of randomised controlled trials investigating the effect of IGL. Furthermore, systematic glucose-insulin-potassium infusion (GIK) has been studied to improve outcome after AMI. In spite of positive findings in some early studies, GIK did not show any beneficial effects in recent clinical trials and thus this concept has been abandoned. While IGL targeted to achieve normoglycaemia improves outcome in patients with AMI, achievement of glucose regulation is difficult and carries the risk of hypoglycaemia. More research is needed to determine the optimal glucose target levels in AMI and to investigate whether computerised glucose protocols and continuous glucose sensors can improve safety and efficacy of IGL.
No takes yet. Share an insight, caveat, or question.
Lipton et al. (2011) conducted a systematic review in Acute coronary syndrome. Intensive glucose-lowering therapy (IGL) and glucose-insulin-potassium (GIK) infusion vs. Standard treatment was evaluated. Intensive glucose-lowering therapy can improve survival in acute myocardial infarction, but systematic glucose-insulin-potassium infusion lacks benefit in the reperfusion era and has been abandoned.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: