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Inexpensive Infusion for Myocardial Infarction Patients Results in 72 Percent Lower Mortality
"In the subgroup of patients without signs of heart failure at admission, the addition of glucose-insulin-potassium infusion to primary coronary angioplasty significantly reduced mortality. Over nine out of 10 patients belong to this subgroup," said Iwan C. C. van der Horst, MD at the Hospital de Weezenlanden in Zwolle, Netherlands.
It is believed that glucose provides most of the benefit, with potassium and insulin helping the glucose enter heart muscle cells.
From April 1998 to September 2001, 940 heart attack patients who were being evaluated for same-day angioplasty treatment were randomly assigned by open-label, to either a continuous glucose-insulin-potassium infusion for eight to 12 hours, or to no infusion. All patients went on to receive angiography testing and then angioplasty, if indicated according to usual practice.
Overall, there was no statistically significant difference in 30-day death rates for the "no infusion" group (5.8 percent) compared to the patients receiving glucose-insulin-potassium (4.8 percent). However, when 84 patients showing signs of heart failure were removed from the analysis, a clear benefit appeared among the 856 remaining patients. In this subgroup, which included the overwhelming majority of patients, the 30-day mortality was almost 72 percent lower among the patients receiving the infusion (1.2 percent vs. 4.2 percent).
Although the researchers said this study does not explain why a glucose-insulin-potassium infusion would not help patients with heart failure, they noted that the large volume of the infusion is a concern.
"Also the effect of glucose-insulin-potassium on secondary endpoints is interesting. In this article the effect of glucose-insulin-potassium on recurrent myocardial infarction and repeat angioplasty are mentioned. The combined endpoint of 30-day mortality, recurrent myocardial infarction and repeat angioplasty was significantly lower in patients without signs of heart failure treated with glucose-insulin-potassium. And even in the overall population, after correction for baseline differences, a strong trend was observed," Dr. van der Horst said.
Despite the dramatic apparent benefit among the majority of heart attack patients in this study, the researchers said their results need to be confirmed.
"To change current recommendations on the treatment of patients with acute myocardial infarction, it is likely that a new study has to confirm the beneficial results of the glucose-insulin-potassium infusion," Dr. van der Horst said.
Carl S. Apstein, MD at the Boston University School of Medicine in Boston, who wrote an editorial in the journal, called the results reported by van der Horst et al. remarkable.
"I consider this to be a landmark study for the treatment of myocardial infarction," Dr. Apstein said. "It has the potential to reduce the absolute mortality rate by 3 percent, saving approximately 30,000 lives per year, if one could extrapolate this Dutch study to the U.S., and there's no reason why one couldn't," he added.
Dr. Apstein said follow-up studies should be undertaken in the United States, including some that could investigate whether beginning the glucose-insulin-potassium infusion earlier might offer additional benefit. He said that the generic solution is inexpensive and could be easily included in standard therapy if follow-up studies confirm the life-saving benefit seen in this trial.
Download the study here: https://www.acc.org/media/releases/highlights/2003/sept03/inexpensive.pdf
Source: The American College of Cardiology