Glucose-Insulin-Potassium as an Adjunctive Therapy in Acute Myocardial Infarction

Background and Objectives:Glucose-insulin-potassium (GIK) fluid infusion may improve myocardial energy metabolism in ischemic condition. A prospective randomized clinical trial was designed to determine whether a GIK fluid infusion can reduce ventricular remodeling in acute myocardial infarction. Subjects and Methods:For patients with acute myocardial infarction, during thrombolytic therapy with urokinase, GIK fluid (26% glucose 1000 mL, 50 IU insulin, and 80 mmol KCl) was administered for 24 hours. The ventricular volumes and function were evaluated by echocardiography during admission period, at 6 months and at 12 months following discharge. Results:This trial was done prospectively for 2 years in 73 patients; GIK group included 41 patients and control group included 32 patients. The median value of the pain to door time was 195 minutes in GIK group and it was 120 minutes in control group (p=NS). The wall motion score was 1.52±0.39 in GIK group and it was 1.39±0.35 in control group. The left ventricular volumes, ejection fractions, cardiac indices and globular indices showed no significant difference between two groups. The side effects of GIK fluid were mild phlebitis in 6 patients (14.6%) and congestive heart failure in 5 patients (12.2%). Conclusion:This trial could not verify beneficial effects of administering GIK fluid on ventricular remodeling after acute myocardial infarction. The limitations of this trial were as follows: the pain to door time was too long and severity of myocardial infarction was mild. Low rates for echo- cardiogrphy follow-up and randomization failure in a few patients were also noted. (Korean Circulation J 2005;35:779-786)