Glucose-insulin-potassium infusion for myocardial protection during off-pump coronary artery surgery

Lell, William A.; Nielsen, Vance G.; McGiffin, David C.; Schmidt, F; Kirklin, James K.; Stanley, Alfred W.H.

doi:10.1016/s0003-4975(01)03619-0

Cited by 48 publications

(40 citation statements)

References 20 publications

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“…Glucose-insulin-potassium was also shown to improve outcomes in cardiac surgery patients when blood glucose concentrations were well controlled 497 but not when blood glucose concentrations were inadequately controlled. 498 The benefit of glucose-insulin-potassium to produce cardioprotection in nonhyperglycemic cardiac surgery patients is controversial and may not be similar to the use of insulin to specifically control blood glucose concentration. 506 The role of intraoperative glycemic control with a standardized insulin protocol to modulate outcomes was investigated in a prospective observational study of patients with diabetes mellitus undergoing CABG surgery.…”

Section: Intra-aortic Balloon Counterpulsation Devicementioning

confidence: 99%

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Fleisher¹,

Beckman²,

Brown³

et al. 2007

Circulation

626

281

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Section: Intra-aortic Balloon Counterpulsation Devicementioning

confidence: 99%

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

Fleisher¹,

Beckman²,

Brown³

et al. 2007

Circulation

626

281

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“…However, the reader should be aware that a vast body of literature also exists on the use of GIK, insulin-glucose, or insulin alone in critically ill patients (due to various causes) in the intensive care unit, as well as in the cardiac surgery patient. [53][54][55][56][57][58][59][60] Although it is beyond the scope of the present article to review these studies in depth, several highlights of this field are worthy of attention and are presented in the online-only Data Supplement.…”

Section: Gik Insulin-glucose In the Intensive Care Setting And With mentioning

confidence: 99%

“…(59) However, as in the acute myocardial infarction literature there are also negative studies. Lell et al (60) in 2002 failed to show a benefit of GIK on release of cardiac enzymes in patients undergoing elective off -pump coronary artery bypass surgery. However, in this study GIK induced hyperglycemia.…”

Section: World Wide Web Atmentioning

confidence: 99%

Glucose-Insulin-Potassium for Acute Myocardial Infarction

Kloner

Nesto

2008

Circulation

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T he "holy grail" in the field of cardioprotection is to develop pharmacological agents that can be administered as adjunctive treatment to reperfusion that will reduce myocardial infarct size and improve clinical outcomes. Numerous pharmacological agents and strategies have been studied over the years with variable results in both animal models and humans. Of drugs that have been studied, only a few have shown benefit in clinical trials. Aside from agents or devices than can restore and maintain reperfusion (thrombolytics, balloons, stents, aspirin, clopidogrel, IIb/IIIa inhibitors, lowmolecular-weight heparin, and others), the only commonly used adjunctive agents shown to have cardioprotective effects when administered early after coronary occlusion and in addition to reperfusion are ␤-blockers. Angiotensinconverting enzyme inhibitors and angiotensin receptor blockers are also used, but these can be given after infarction (as late as 1 week) and must be continued long-term to reduce left ventricular remodeling. Recently, adenosine and induced hypothermia have also shown promise as early adjunctive agents. For example, when intravenous adenosine was coupled with early reperfusion therapy, myocardial infarct size by single-photon emission computed tomography analysis and the composite end point of death and heart failure were reduced at 6 months. 1 Hypothermia, induced by use of a heat-exchange cooling catheter, benefited a subgroup of patients who were successfully cooled to Յ35°C before reperfusion. 2 Superoxide dismutase, magnesium, inhibitors of neutrophil adhesion, complement inhibitors, fluosol, RheothRx, the K ATP channel/nitrate nicorandil, and others failed to show a benefit as adjuncts to reperfusion. 3 Clinical research evaluating many of these agents in acute myocardial infarction has halted.One of the most controversial of these adjunctive agents still under investigation is GIK (glucose-insulin-potassium), 4,5 a "cocktail" delivered at the time of infarction that has demonstrated variable results in both the prereperfusion and postreperfusion eras. GIK was one of the first agents to be studied for protection of the ischemic myocardium. 6,7 Numerous reasons exist for the continued interest in GIK despite its variable track record in clinical trials: (1) Substantial laboratory evidence supports a cardioprotective effect in various models of ischemia/reperfusion; (2) some clinical trials have demonstrated positive results in specific patient subgroups; (3) the treatment is relatively "nontoxic" and free of major clinical side effects; and (4) recent evidence suggests that insulin itself, a component of GIK, administered as a strategy to restore normoglycemia, may be cardioprotective because it has antiinflammatory, antiapoptotic, and provasodilatory properties. In addition, the recognition that hyperglycemia is an important independent factor associated with a poor outcome in the setting of acute myocardial infarction 8 and other critical illnesses has renewed interest in the use of insulin. A byprodu...

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“…However, despite the beneficial effects observed experimentally and in small studies, the benefit of GIK in high-risk patients undergoing CABG has not been demonstrated. (43). Thoracic Epidural Anesthesia: Thoracic epidural anesthesia with local anesthetics has been used as a technique capable of promoting perioperative analgesia and reduction of myocardial oxygen consumption by blocking the roots of the thoracic sympathetic fibers from T1 to T5, which provide sympathetic innervation to the heart.…”

Section: Myocardial Protectionmentioning

confidence: 99%