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Cardiovascular highlights from non-cardiology journals
  1. Alistair C Lindsay, Editor

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General cardiology, interventional cardiology

Glucose-insulin-potassium shows some benefit in acute coronary syndrome

Intravenous glucose-insulin-potassium (GIK) is postulated to be beneficial in acute ischaemic syndromes via two mechanisms: by providing metabolic support to ischaemic myocardium, and by preventing arrhythmias and cardiac arrest due to ischaemia-related metabolic derangements. Importantly, these benefits are most likely to be seen if GIK is started as soon as possible after the onset of myocardial ischaemia, therefore GIK should ideally be initiated in the out-of-hospital setting.

The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care trial tested out-of-hospital administration of GIK in the early stages of acute coronary syndrome. The trial took place in 13 US cities over a 5-year period and enrolled 871 patients to either intravenous GIK solution (n=411) or 5% glucose placebo (n=460). The primary endpoint was progression of acute coronary syndrome to myocardial infarction within 24 h, as assessed by biomarkers and the ECG. Secondary endpoints included survival at 30 days, and a composite of cardiac arrest or in-hospital mortality.

The trial found no significant difference in the rate of progression to MI among patients who received GIK (48.7% vs 52.6%, p=0.28). Although 30-day mortality was lower (4.4% vs 6.1%, p=0.28), this did not reach statistical significance, however the composite …

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