Effect of perioperative glucose-insulin-potassium infusions on mortality and atrial fibrillation after coronary artery bypass grafting: A systematic review and meta-analysis

Rabi, Doreen M.; Clement, Fiona; McAlister, Finlay A.; Majumdar, Sumit R.; Sauvé, Reg; Johnson, Jeffrey; Ghali, William A.

doi:10.1016/s0828-282x(10)70394-9

Cited by 23 publications

(9 citation statements)

References 41 publications

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“…181 GIK has shown mixed results in CABG surgery, with a recent meta-analysis showing no improvement in the incidence of arrhythmia or mortality. 182 However, with recent emphasis on tight glucose control during cardiac surgery, many patients receive intraoperative GIK anyway. 183 Results in AMI have been consistently negative, although a recent trial (NCT00091507) of GIK delivery by emergency personnel in the pre-hospital setting yielded a 50% drop in in-hospital cardiac arrest and mortality.…”

Section: Emerging Mitochondrial Therapeutic Targetsmentioning

confidence: 99%

Mitochondria as a Drug Target in Ischemic Heart Disease and Cardiomyopathy

Walters

Porter

Brookes

2012

Circulation Research

239

182

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Ischemic heart disease (IHD) is a significant cause of morbidity and mortality in Western society. Although interventions such as thrombolysis and percutaneous coronary intervention (PCI) have proven efficacious in ischemia and reperfusion (IR) injury, the underlying pathologic process of IHD, laboratory studies suggest further protection is possible, and an expansive research effort is aimed at bringing new therapeutic options to the clinic. Mitochondrial dysfunction plays a key role in the pathogenesis of IR injury and cardiomyopathy (CM). However, despite promising mitochondria-targeted drugs emerging from the lab, very few have successfully completed clinical trials. As such, the mitochondrion is a potential untapped target for new IHD and CM therapies. Notably, there are a number of overlapping therapies for both these diseases, and as such novel therapeutic options for one condition may find use in the other. This review summarizes efforts to date in targeting mitochondria for IHD and CM therapy, and outlines emerging drug targets in this field.

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Section: Emerging Mitochondrial Therapeutic Targetsmentioning

confidence: 99%

Mitochondria as a Drug Target in Ischemic Heart Disease and Cardiomyopathy

Walters

Porter

Brookes

2012

Circulation Research

239

182

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“…Only 6 studies, of 20 analyzed, yielded data on the potassium trend, and from 6 studies, only one provided data on hyperkalemia appearance (12).…”

Section: Discussionmentioning

confidence: 99%

Glucosa-Insulin-Potassium (GIK) Solution Used with Diabetic Patients Provides Better Recovery After Coronary Bypass Operations

Štraus

Gerc

Kacila

et al. 2013

Med Arh

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I ntroduction: Tight blood glucose control has become a therapeutical goal for anesthetic management for patients scheduled for cardiac surgery, especially if they are diabetic patients. Aim: This study was created to confirm the benefits of intraoperative GIK solution usage during coronary bypass operation of diabetic patients. Methods: Patients with type 1 and 2 diabetes mellitus (DM) referred for coronary artery bypass grafting (CABG) were randomized to receive GIK solution (GIK -study group) in the first 24 hours intraoperatively or to receive official Clinical protocol without GIK solution (non GIK -control group). The primary clinical outcome was the cardiac index (CI) since it represents the most sensitive measure of cardiac work in the immediate postoperative period, and the secondary clinical outcomes were the glycemic control, insulin consumption, duration of mechanical ventilation (MV), potassium level and atrial fibrillation (AF) appearance. Results: One hundred diabetic patients, divided into two groups, were included in the study. The cardiac index did not show a significant difference, although the study group had CI with only minor variations than those of the controlled group, hence the reason we considered the study group as the more stable. The atrial fibrillation showed a difference between two groups, with 14 (28%) patients with postoperative AF in the control group compared with 3 (6%) patients with postoperative AF in the study group. As potassium values were stable in study group, we concluded that it can be one of the reasons for less postoperative AF in this group. The duration of MV showed a significant difference (0,003) between the two groups as well. In the study group the average MV time was 534,38 minutes, compared with the control group with 749,20 minutes. The average value of glucose was 11.1 mmol/l in the control group vs. 9.8 mmol/l in the study group. The study group had less insulin consumption in order to maintain target glycemia (p=0,001). In the non GIK group average insulin consumption was 44 IJ per patient vs. 28,5 IJ in the GIK group. Conclusion: Intraoperative GIK solution given to diabetic patients with CABG operation provides more stable CI, shorter time of MV, more stable values of potassium which provides normal rhythm and less AF onset, less insulin to maintain target glycemia. All the above mentioned provides more stable intraoperative hemodynamic and better recovery of diabetic patients with coronary artery bypass operations.

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“…14 The enhancement of K ϩ uptake into tissues by insulin occurs independent of glucose uptake, and the rate of K ϩ uptake in diabetic subjects has been shown to be similar to that in healthy control subjects. 106 However, a separate meta-analysis investigating the effect of perioperative GIK infusion on mortality and AF after coronary artery bypass grafting found no significant reduction in AF by perioperative GIK infusion, 36 and insulin cardioplegia did not decrease the incidence of postoperative arrhythmias compared with placebo in another study. 107 …”

Section: Other Putative Effectsmentioning

confidence: 97%

“…Insulin is recognized as the central component of the GIK cocktail; glucose and potassium are added to adjust for the secondary effects of glycemic alteration and hypokalemia caused by simultaneous cellular uptake of potassium with glucose. Although evidence for the clinical benefit of GIK has been mixed, [33][34][35][36][37] …”

Section: Cardioprotective Effects Of Insulinmentioning

confidence: 99%