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Comparison of glucose-insulin-potassium and insulin-glucose as adjunctive therapy in acute myocardial infarction: a contemporary meta-analysis of randomised controlled trials
  1. Yun-Tao Zhao1,
  2. Cui-Lian Weng2,
  3. Mu-Lei Chen1,
  4. Kui-Bao Li1,
  5. Yong-Gui Ge1,
  6. Xiang-Min Lin1,
  7. Wen-Shu Zhao1,
  8. Jin Chen1,
  9. Lin Zhang1,
  10. Jun-Xiang Yin3,
  11. Xin-Chun Yang1
  1. 1Department of Cardiology, Beijing Chaoyang Hospital, Affiliate of Capital Medical University, Beijing, China
  2. 2Intensive Care Unit, The First Affiliated Hospital of Xiamen University, Xiamen, China
  3. 3China National Center for Biotechnology Development, The Ministry of Science and Technolog, Beijing, China
  1. Correspondence to Xin-Chun Yang, Department of Cardiology, Beijing Chaoyang Hospital, Affiliate of Capital Medical University, Beijing, China; raasraas{at}gmail.com

Abstract

Background There is conflicting evidence regarding two different insulin regimens for acute myocardial infarction (AMI), one focusing on delivering insulin (‘insulin focus’, glucose-insulin-potassium (GIK)) and one focusing on tight glycaemic control (‘glycaemia focus’, insulin-glucose). A longstanding controversy has focused on which strategy provides the greatest reduction in mortality. The aim of this study was to perform a meta-analysis of randomised controlled trials (RCTs) comparing GIK or insulin-glucose therapy versus standard therapy for AMI in the reperfusion era.

Methods A MEDLINE/EMBASE/CENTRAL search was conducted of RCTs evaluating GIK or insulin-glucose as adjunctive therapy for AMI. The primary endpoint was all-cause mortality. The data were analysed with a random effect model.

Results A total of 11 studies (including 23 864 patients) were identified, eight evaluating insulin focus with GIK and three evaluating glycaemia focus with insulin-glucose. Overall, insulin focus with GIK was not associated with a statistically significant effect on mortality (RR 1.07, 95% CI 0.89 to 1.29, p=0.487). Before the use of reperfusion, GIK also had no clear impact on mortality (RR 0.92, 95% CI 0.70 to 1.20, p=0.522). Pooled data from the three studies evaluating glycaemia focus showed that insulin-glucose did not reduce mortality in the absence of glycaemia control in patients with AMI with diabetes (RR 1.07, 95% CI 0.85 to 1.36, p=0.547).

Conclusions Current evidence suggests that GIK with insulin does not reduce mortality in patients with AMI. However, studies of glycaemia are inconclusive and it remains possible that glycaemic control is beneficial.

  • Glucose-insulin-potassium
  • acute myocardial infarction
  • insulin focus
  • glycaemia focus
  • reperfusion
  • stemi

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Footnotes

  • Y-T Z and C-L W are co-authors and contributed equally to the manuscript.

  • Competing interests None.

  • Ethics approval This study was a meta-analysis which did not require ethics approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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