Myocardial protection by glucose-insulin-potassium in acute coronary syndrome patients undergoing urgent multivessel off-pump coronary artery bypass surgery

J. K. Shim, S. Y. Yang, Y. C. Yoo, K. J. Yoo, Y. L. Kwak

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BackgroundThe aim of this randomized and controlled trial was to investigate the effect of a glucose-insulin-potassium (GIK) solution on myocardial protection in acute coronary syndrome (ACS) patients undergoing urgent multivessel off-pump coronary artery bypass (OPCAB) surgery.MethodsSixty- six patients were randomly allocated either to receive 0.3 ml kg -1 h -2 GIK solution (potassium 80 mEq and regular insulin 325 IU in 500 ml of 50% glucose) or equivalent volume of normal saline (control) upon anaesthetic induction until 6 h after reperfusion. The primary endpoints were to compare the concentrations of creatine kinase-MB (CK-MB) and troponin-T between the groups after reperfusion. The secondary endpoints were to compare the incidences of postoperative troponin-T >0.8 ng ml -1 and myocardial infarction (MI) between the groups.ResultsHighest CK-MB [8.7 (4.4) vs 13.1 (7.9) ng ml -1 , P=0.006] and troponin-T [0.20 (0.13-0.49) vs 0.48 (0.18-0.91) ng ml -1 , P<0.0001] values after reperfusion were significantly lower in the GIK group compared with the control group. The area under the curve of serially measured troponin-T was also significantly smaller in the GIK group compared with the control group [0.83 (0.43-1.81) vs 0.46 (0.31-1.00), P=0.036]. Significantly fewer patients in the GIK group showed troponin-T >0.8 ng ml -1 after reperfusion compared with the control group (3 vs 11, P=0.033). The incidence of postoperative MI was similar between the groups.ConclusionsGIK administration in ACS patients undergoing urgent multivessel OPCAB significantly attenuated the degree of ensuing myocardial injury without complications related to glycaemic control.Clinical Trial Registry. URL: http://clinicaltrials.gov/ct2/show/NCT01384656?term= GIK+AND+OPCAB&rank=1. Unique identification number NCT01384656.

Original languageEnglish
Pages (from-to)47-53
Number of pages7
JournalBritish Journal of Anaesthesia
Volume110
Issue number1
DOIs
Publication statusPublished - 2013 Jan

Fingerprint

Off-Pump Coronary Artery Bypass
Troponin T
Acute Coronary Syndrome
Coronary Artery Bypass
Reperfusion
MB Form Creatine Kinase
Potassium
Insulin
Glucose
Myocardial Infarction
Incidence
Registries
Anesthetics
Randomized Controlled Trials
Clinical Trials
Control Groups
Wounds and Injuries
glucose-insulin-potassium cardioplegic solution

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

@article{300168fb49d046fea16cd3317c90f070,
title = "Myocardial protection by glucose-insulin-potassium in acute coronary syndrome patients undergoing urgent multivessel off-pump coronary artery bypass surgery",
abstract = "BackgroundThe aim of this randomized and controlled trial was to investigate the effect of a glucose-insulin-potassium (GIK) solution on myocardial protection in acute coronary syndrome (ACS) patients undergoing urgent multivessel off-pump coronary artery bypass (OPCAB) surgery.MethodsSixty- six patients were randomly allocated either to receive 0.3 ml kg -1 h -2 GIK solution (potassium 80 mEq and regular insulin 325 IU in 500 ml of 50{\%} glucose) or equivalent volume of normal saline (control) upon anaesthetic induction until 6 h after reperfusion. The primary endpoints were to compare the concentrations of creatine kinase-MB (CK-MB) and troponin-T between the groups after reperfusion. The secondary endpoints were to compare the incidences of postoperative troponin-T >0.8 ng ml -1 and myocardial infarction (MI) between the groups.ResultsHighest CK-MB [8.7 (4.4) vs 13.1 (7.9) ng ml -1 , P=0.006] and troponin-T [0.20 (0.13-0.49) vs 0.48 (0.18-0.91) ng ml -1 , P<0.0001] values after reperfusion were significantly lower in the GIK group compared with the control group. The area under the curve of serially measured troponin-T was also significantly smaller in the GIK group compared with the control group [0.83 (0.43-1.81) vs 0.46 (0.31-1.00), P=0.036]. Significantly fewer patients in the GIK group showed troponin-T >0.8 ng ml -1 after reperfusion compared with the control group (3 vs 11, P=0.033). The incidence of postoperative MI was similar between the groups.ConclusionsGIK administration in ACS patients undergoing urgent multivessel OPCAB significantly attenuated the degree of ensuing myocardial injury without complications related to glycaemic control.Clinical Trial Registry. URL: http://clinicaltrials.gov/ct2/show/NCT01384656?term= GIK+AND+OPCAB&rank=1. Unique identification number NCT01384656.",
author = "Shim, {J. K.} and Yang, {S. Y.} and Yoo, {Y. C.} and Yoo, {K. J.} and Kwak, {Y. L.}",
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Myocardial protection by glucose-insulin-potassium in acute coronary syndrome patients undergoing urgent multivessel off-pump coronary artery bypass surgery. / Shim, J. K.; Yang, S. Y.; Yoo, Y. C.; Yoo, K. J.; Kwak, Y. L.

In: British Journal of Anaesthesia, Vol. 110, No. 1, 01.2013, p. 47-53.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Myocardial protection by glucose-insulin-potassium in acute coronary syndrome patients undergoing urgent multivessel off-pump coronary artery bypass surgery

AU - Shim, J. K.

AU - Yang, S. Y.

AU - Yoo, Y. C.

AU - Yoo, K. J.

AU - Kwak, Y. L.

PY - 2013/1

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N2 - BackgroundThe aim of this randomized and controlled trial was to investigate the effect of a glucose-insulin-potassium (GIK) solution on myocardial protection in acute coronary syndrome (ACS) patients undergoing urgent multivessel off-pump coronary artery bypass (OPCAB) surgery.MethodsSixty- six patients were randomly allocated either to receive 0.3 ml kg -1 h -2 GIK solution (potassium 80 mEq and regular insulin 325 IU in 500 ml of 50% glucose) or equivalent volume of normal saline (control) upon anaesthetic induction until 6 h after reperfusion. The primary endpoints were to compare the concentrations of creatine kinase-MB (CK-MB) and troponin-T between the groups after reperfusion. The secondary endpoints were to compare the incidences of postoperative troponin-T >0.8 ng ml -1 and myocardial infarction (MI) between the groups.ResultsHighest CK-MB [8.7 (4.4) vs 13.1 (7.9) ng ml -1 , P=0.006] and troponin-T [0.20 (0.13-0.49) vs 0.48 (0.18-0.91) ng ml -1 , P<0.0001] values after reperfusion were significantly lower in the GIK group compared with the control group. The area under the curve of serially measured troponin-T was also significantly smaller in the GIK group compared with the control group [0.83 (0.43-1.81) vs 0.46 (0.31-1.00), P=0.036]. Significantly fewer patients in the GIK group showed troponin-T >0.8 ng ml -1 after reperfusion compared with the control group (3 vs 11, P=0.033). The incidence of postoperative MI was similar between the groups.ConclusionsGIK administration in ACS patients undergoing urgent multivessel OPCAB significantly attenuated the degree of ensuing myocardial injury without complications related to glycaemic control.Clinical Trial Registry. URL: http://clinicaltrials.gov/ct2/show/NCT01384656?term= GIK+AND+OPCAB&rank=1. Unique identification number NCT01384656.

AB - BackgroundThe aim of this randomized and controlled trial was to investigate the effect of a glucose-insulin-potassium (GIK) solution on myocardial protection in acute coronary syndrome (ACS) patients undergoing urgent multivessel off-pump coronary artery bypass (OPCAB) surgery.MethodsSixty- six patients were randomly allocated either to receive 0.3 ml kg -1 h -2 GIK solution (potassium 80 mEq and regular insulin 325 IU in 500 ml of 50% glucose) or equivalent volume of normal saline (control) upon anaesthetic induction until 6 h after reperfusion. The primary endpoints were to compare the concentrations of creatine kinase-MB (CK-MB) and troponin-T between the groups after reperfusion. The secondary endpoints were to compare the incidences of postoperative troponin-T >0.8 ng ml -1 and myocardial infarction (MI) between the groups.ResultsHighest CK-MB [8.7 (4.4) vs 13.1 (7.9) ng ml -1 , P=0.006] and troponin-T [0.20 (0.13-0.49) vs 0.48 (0.18-0.91) ng ml -1 , P<0.0001] values after reperfusion were significantly lower in the GIK group compared with the control group. The area under the curve of serially measured troponin-T was also significantly smaller in the GIK group compared with the control group [0.83 (0.43-1.81) vs 0.46 (0.31-1.00), P=0.036]. Significantly fewer patients in the GIK group showed troponin-T >0.8 ng ml -1 after reperfusion compared with the control group (3 vs 11, P=0.033). The incidence of postoperative MI was similar between the groups.ConclusionsGIK administration in ACS patients undergoing urgent multivessel OPCAB significantly attenuated the degree of ensuing myocardial injury without complications related to glycaemic control.Clinical Trial Registry. URL: http://clinicaltrials.gov/ct2/show/NCT01384656?term= GIK+AND+OPCAB&rank=1. Unique identification number NCT01384656.

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