One‐Year Outcome of Intensive Insulin Therapy Combined to Glucose‐Insulin‐Potassium in Acute Coronary Syndrome: A Randomized Controlled Study

Autor: Malek Echeikh, Hamdi Boubaker, Adel Sekma, Mohamed Habib Grissa, Ines Khochtali, Malek Mzali, Kaouthar Beltaief, Wahid Bouida, Fadhel Najjar, Semir Nouira, Mohsen Hassine, Riadh Boukef, Zohra Dridi, Mohamed Amine Msolli, Asma Belguith, Nasri Bzeouich
Rok vydání: 2017
Předmět:
Male
medicine.medical_specialty
Acute coronary syndrome
Time Factors
Complications
medicine.medical_treatment
030204 cardiovascular system & hematology
acute coronary syndrome
law.invention
Electrocardiography
03 medical and health sciences
intensive insulin therapy
0302 clinical medicine
Randomized controlled trial
law
Internal medicine
Humans
Hypoglycemic Agents
Insulin
Coronary Heart Disease
Medicine
Prospective Studies
030212 general & internal medicine
Intensive care medicine
Cardioplegic Solutions
Original Research
Dose-Response Relationship
Drug
Restenosis
Glucose insulin potassium
business.industry
Middle Aged
medicine.disease
Glucose
Potassium
glucose‐insulin‐potassium
Drug Therapy
Combination
Female
prognosis
pharmacology
Mortality/Survival
Cardiology and Cardiovascular Medicine
business
Acute Coronary Syndromes
Follow-Up Studies
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: Background A number of factors may offset the cardioprotective effects of glucose‐insulin‐potassium (GIK) on outcome of patients with acute coronary syndrome, such as hyperglycemia induced by this cocktail infusion. We performed a study to evaluate the effect of intensive insulin therapy in association with GIK on 1‐year outcome in patients hospitalized for acute coronary syndrome. Methods and Results In a randomized prospective controlled trial we included 772 patients with non–ST‐segment elevation acute coronary syndrome. Patients were randomized into 3 groups: GIKI 2 group, who received GIK with intensive insulin therapy for 24 hours; GIK group, who received GIK with nonintensive insulin therapy; and control group, who received usual care. The primary outcome criteria were the rates of major cardiovascular events combining death, reinfarction, and stroke rate at 1 year. In addition, we measured platelet function assay‐100 and plasminogen activator inhibitor‐1 at admission and 24 hours later. Based on an intention‐to‐treat analysis, major cardiovascular events at 1 year was 12.8% in the GIKI 2 group, 15.5% in the GIK group, and 20.5% in the placebo group; the difference was significant between the GIK 2 and control groups ( P =0.01). Platelet function assay‐100 at 24 hours decreased significantly from baseline in the control group but not in the GIKI 2 group. Plasminogen activator inhibitor‐1 decreased significantly in the GIKI 2 group but significantly increased in the control group. Minor hypoglycemic events were more frequent in the GIKI 2 group compared with other groups. Conclusions GIKI 2 led to improvement of 1‐year outcome rates in patients with non–ST‐segment elevation acute coronary syndrome. This beneficial effect was associated with a decrease in platelet reactivity and an increase on fibrinolysis tests. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT00965406.
Databáze: OpenAIRE
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