The effect of glucose–insulin–potassium treatment on myocardial oxidative stress in patients with acute coronary syndromes undergoing percutaneous coronary intervention

Demircan, Sabri; Yazıcı, Mustafa; Diraman, Emine; Demircan, Günnur; Kılıçaslan, Fethi; Durna, Kenan; Acar, Zeydin; Eren, Zafer

doi:10.1097/mca.0b013e3282f27c34

Cited by 16 publications

(19 citation statements)

References 46 publications

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“…The current study also revealed that the level of PAB in the high-dose KCl (20 µg/kg) group was markedly decreased compared with the low-dose KCl (10 µg/kg) group. In patients with acute coronary syndromes, antioxidant activity for scavenging myocardial-free radicals can be increased by the administration of a solution of glucose-insulin-K, 30 indicating that the restoration of intracellular K (ie, K + outside mitochondria) by elevated serum levels of K after the injection of KCl could promote the activity of antioxidant enzymes, especially with the administration of high-dose KCl.…”

Section: Discussionmentioning

confidence: 99%

Effects of Acute Potassium Chloride Administration on Ventricular Dysrhythmias after Myocardial Infarction in a Rat Model of Ischemia/Reperfusion

Madadi¹,

Aghajani²,

Dabbagh³

et al. 2022

JTHC

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Background: Acute myocardial infarction is an important cause of morbidity. This study aimed to investigate the effects of the administration of potassium chloride (KCl) on reperfusion-induced injuries in a rat model of myocardial ischemia/reperfusion. Methods: Thirty-six male Wistar rats, weighing 200 to 250 g, were randomly assigned to 3 experimental groups: control, K1 (10 µg/kg of KCl), and K2 (20 µg/kg of KCl). Twenty minutes before ischemia, a single dose of 10 and 20 µg/kg of KCl was intraperitoneally administered in the K1 and K2 groups, respectively. The coronary artery was occluded for 30 minutes (ischemia); thereafter, it was opened for 60 minutes (reperfusion) to measure hemodynamic parameters and ventricular arrhythmias. Blood sampling was performed after the reperfusion period to determine the serum levels of lactate dehydrogenase, troponin I, creatine kinase (CK)-MB, malondialdehyde, and pro-oxidant-antioxidant balance. Results: Serological parameters significantly decreased in the potassium groups compared with the control group. In particular, the decline was more pronounced for the serum levels of lactate dehydrogenase (1180.25±69.48 vs 1556.67±77.02 U/L; P=0.011), troponin I (21.98±0.61 vs 28.76±1.65 ng/mL; P=0.020), and pro-oxidant-antioxidant balance (15.51±0.72 vs 20.63±1.42 HK; P=0.041) in the K2 group compared with the K1 group. Moreover, the administration of 20 µg/kg of KCl significantly decreased the incidence of ventricular tachycardias and fibrillations compared with the control group (P=0.002). Additionally, no considerable differences were observed between the control group and the groups with 10 µg/kg and 20 µg/kg of KCl regarding the number of ventricular ectopic beats. Conclusion: The administration of KCl before ischemia could reduce ventricular arrhythmias and reperfusion-induced injuries by reducing oxidative stress.

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Section: Discussionmentioning

confidence: 99%

Effects of Acute Potassium Chloride Administration on Ventricular Dysrhythmias after Myocardial Infarction in a Rat Model of Ischemia/Reperfusion

Madadi¹,

Aghajani²,

Dabbagh³

et al. 2022

JTHC

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show abstract

“…An investigation by Ekeløf et al indicated that SOD was reduced significantly at 2 h after PTCA (42), which suggests that the consumption of SOD may require a series of processes. However, a study by Demircan et al indicated that SOD was immediately reduced after PCI compared to the pre-PCI subgroup (43). These controversial results require further investigation due to the limited sample sizes employed.…”

Section: Discussionmentioning

confidence: 99%

Impact of intracoronary nicorandil before stent deployment in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Liu

et al. 2019

Exp Ther Med

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The present study aimed to clarify the effect of bolus intracoronary nicorandil on inflammatory, oxidative and adherent indicators in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This randomized controlled trial (RCT) was performed to detect the inflammation and oxidative stress in intracoronary blood both before and after PCI. In total, 65 consecutive patients undergoing PCI were classified into a nicorandil therapy group (n=32) or a placebo group (n=33). All procedures were performed at Shandong University Qilu Hospital, China, during the period from March, 2016 to May, 2017. Intracoronary blood from patients who received nicorandil therapy during PCI showed no change in soluble CD40 ligand (sCD40L) concentration (1.86±0.08 vs. 1.90±0.09 ng/ml, P=0.12) but a significant increase was noted in the control group (1.87±0.17 vs. 2.82±0.26 ng/ml, P<0.01). This indicated a relative reduction in sCD40L level after PCI in the nicorandil group. We further demonstrated an increase in superoxide dismutase (SOD) activity (29.37±0.81 vs. 31.03±0.60 U/ml, P<0.001) and a reduction in lipid peroxidation (3.84±0.99 vs. 4.23±0.13 U/ml, P=0.001) in the nicorandil group but observed no change in the placebo group. ICAM-1 levels showed no change in the nicorandil group (69.54±6.89 vs. 72.01±8.25 ng/ml, P=0.83) but a significant increase in the control group after PCI in intracoronary blood (56.57±4.96 vs. 76.81±6.88 ng/ml, P=0.002). No changes were found in hs-CRP, TNFα and sVCAM-1 levels in coronary blood for both groups before and after PCI in ACS patients. Our findings demonstrate that intracoronary bolus nicorandil therapy has a significant effect on the inhibition of inflammatory indicators and oxidative stress in patients with ACS during PCI. This suggests a possible medical application of nicorandil for reducing inflammation and oxidative stress.

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“…The cardioprotective effect of insulin can improve clinical outcomes for patients undergoing cardiac surgery. For instance, perioperative insulin administration, coupled with glucose and insulin administration while maintaining normoglycemia (i.e., the GIN therapy), and the glucoseinsulin-potassium (GIK) concept have been shown to improve left ventricular function in coronary artery bypass graft (CABG) surgery [47,48], attenuate the degree of myocardial injury in off-pump coronary artery bypass (OPCAB) surgery [49], reduce the incidence of low cardiac output state, and the need for inotropic support in patients with aortic stenosis undergoing aortic valve replacement [50] as well as prevent myocardial oxidative stress in patients with acute coronary syndrome who are undergoing percutaneous coronary intervention [51].…”

Section: Perioperative Benefits Of Insulinmentioning

confidence: 99%

Perioperative insulin therapy

et al. 2017

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Surgical patients commonly develop hyperglycemia secondary to the neuroendocrine stress response. Insulin treatment of hyperglycemia is required to overcome the perioperative catabolic state and acute insulin resistance. Besides its metabolic actions on glucose metabolism, insulin also displays nonmetabolic physiological effects. Preoperative glycemic assessment, maintenance of normoglycemia, and avoidance of glucose variability are paramount to optimize surgical outcomes. This review discusses the basic physiology and effects of insulin as well as practical issues pertaining to its management during the perioperative period.

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The effect of glucose–insulin–potassium treatment on myocardial oxidative stress in patients with acute coronary syndromes undergoing percutaneous coronary intervention

Abstract: In patients with ACSs, reactive local enzyme activity increases for the scavenging to myocardial-free radicals during PCI. Administration of a solution of GIK as a metabolic support agent might prevent oxidative stress in the myocardial level, in these patients.

Cited by 16 publications

References 46 publications

Effects of Acute Potassium Chloride Administration on Ventricular Dysrhythmias after Myocardial Infarction in a Rat Model of Ischemia/Reperfusion

Effects of Acute Potassium Chloride Administration on Ventricular Dysrhythmias after Myocardial Infarction in a Rat Model of Ischemia/Reperfusion

Impact of intracoronary nicorandil before stent deployment in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Perioperative insulin therapy

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