Controlled Trial of Intravenous Glucose, Potassium, and Insulin in Acute Myocardial Infarction

Pentecost, B L; Mayne, N; Lamb, Patricia W.

doi:10.1016/s0140-6736(68)90903-3

Cited by 69 publications

(16 citation statements)

References 9 publications

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“…The rationale for such therapy was based on the possible modifications which could be induced by this solution: (1) repletion of intracellular potassium lost during myocardial ischemia; (2) suppression of high FFA levels with resul tant diminution of arrhythmias; (3) enhancement of myocardial energy produc tion through anaerobic glycolysis by increasing substrate availability. Unfortu nately, the early reports of the beneficial effects of G1K on the course of acute myocardial infarction have not been substantiated by subsequent large-scale controlled trials (1,6,9,18,20,(28)(29)(30). However, in a recent study, patients treated with GIK had fewer complications and lower mortality than an un treated group of patients (31 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of Glucose-Insulin-Potassium Infusion on the Angina Response during Treadmill Exercise

Thadani¹,

Chiong²,

Parker³

1979

Cardiology

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The effects of glucose-insulin-potassium (GIK) and placebo normal saline (S) infusion on treadmill-walking time to angina, ST depression, heart rate (HR), systolic blood pressure (SBP), rate pressure product (RPP), blood glucose (G), lactate (L) and free fatty acids (FFA) were studied in 14 non diabetic patients with exertional angina. For the whole group, the post-GIK walking time to angina (393 ± 33 sec, mean ± SEM) was greater than the values during control GIK (319 ± 20 sec, p < 0.02) and post-S infusion (334 ± 23 sec, p < 0.05), but circulatory and ST responses were similar in post-GIK and post-S studies. 7 of the 14 patients experienced significantly greater improvement in exercise tolerance following GIK (467 ± 39 sec) in comparison to control GIK (313 ± 29 sec, p < 0.001) and post-S infusion (334 ± 32 sec, p < 0.005) and exercised to a higher HR, SBP and RPP after GIK than after S infusion. At the onset of angina these patients had similar ST-segment depression before and after GIK but when ST segments were assessed after GIK at the same exercise duration when angina had occurred during the control and post-S studies, there was significantly less ST depression (p < 0.01). Of the remaining 7 patients exercise tolerance following GIK deteriorated in 3, remained unchanged in 2 and increased by 12 and 48 sec in 2 patients in comparison to post-S values. Comparison of post-GIK and post-S values for G, L and FFA for the whole group showed significantly lower resting values of FFA and post-exercise values of G following GIK infusion. The differences in clinical and circulatory responses between patients who improved and those who did not improve following GIK were not related to the angiographically determined severity of coronary artery disease or to GIK-induced metabolic changes. Results suggest that some patients with angina pectoris do benefit from GIK infusion but the response in a given patient to this therapeutic modality is unpredictable.

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Section: Discussionmentioning

confidence: 99%

Effects of Glucose-Insulin-Potassium Infusion on the Angina Response during Treadmill Exercise

Thadani¹,

Chiong²,

Parker³

1979

Cardiology

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“…Several workers-v 21,25 have advised against the polarizing treatment. In all of them, stereotyped "polarizing" solutions were prescribed.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiologic basis of use of a polarizing solution in the treatment of myocardial infarction

Prasad

M.D.

1971

Clin Pharma and Therapeutics

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“…The clinical experience of Sodi-Pollares shows this therapy to increase the probability of survival after myocardial infarction [59], However, this study does not involve a concurrent control group -a criticism which also can be levelled against studies by Fritz [16] and Kernohan [25]. Other workers also have not obtained a reduction in mortality with this polarizing solution [13,32,33,46,56], though a few have noted a non-significant reduction in mortality [44,47] or in the fre quency of arrhythmia [31]. The sole important study confirming SodiPollares' experience is that of Mittra [36] and the promoter of this method has since replied that the various authors cited did not follow closely his therapeutic recommendations [58],…”

Section: The So-called 'Polarizing' Solutionsmentioning

confidence: 96%

The Difficulty of Appraisal of Streptokinase Treatment of Myocardial Infarction

Verstraete¹

1971

J Vasc Res

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Considerable advances have been made in clinical pharmacology of late, permitting more precise evaluation of new drugs. This must be taken into account in assessing the thrombolytic therapy of acute myocardial infarction. Clinical trials necessitate control groups, which must in volve a sufficiently large number of patients so that differences are not due to chance. To be valid, the groups must be strictly comparable. It is essential to define precisely criteria for admission and contraindications, if possible stratifying the patients, since the final evaluation must include all patients according to the treatment originally allocated. For recent myocardial infarction, it is important to compare thrombolytic therapy with the best treatment currently available, the patients being randomly allocated to these alternatives. However, it is not clear whether the best current treatment is anticoagulation, polarizing solutions (combining glucose, insulin and potassium), prophylactic antiarrhythmic drugs (procainamide, lignocaine) or <i>β</i>-adrenergic inhibitors (propranolol), and therefore which to use in comparison. The trend to coronary care units already has shown a reduction in mortality, perhaps necessitating evaluation of thrombolytic therapy only in such units. If thrombolysis finds a place in the management of myocardial infarction, treatment must start within the first hours following onset of symptoms. This increases the likelihood that patients diagnosed erroneously also will be treated with thrombolytic agents. Reassurance is needed that such treatment is harmless in these circumstances. Lastly, the statistical interpretation of the value of thrombolytic therapy must be regarded as a ‘two-tailed’ situation.

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Controlled Trial of Intravenous Glucose, Potassium, and Insulin in Acute Myocardial Infarction

Cited by 69 publications

References 9 publications

Effects of Glucose-Insulin-Potassium Infusion on the Angina Response during Treadmill Exercise

Effects of Glucose-Insulin-Potassium Infusion on the Angina Response during Treadmill Exercise

Electrophysiologic basis of use of a polarizing solution in the treatment of myocardial infarction

The Difficulty of Appraisal of Streptokinase Treatment of Myocardial Infarction

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