1 / 9

Glucose-Insulin-Potassium (GIK) in AMI

Glucose-Insulin-Potassium (GIK) in AMI. Glucose-insulin-potassium “cocktail”. Proposed mechanisms of benefit. Glucose (G) Energy efficiency of the heart—becomes p referred fuel Insulin (I) Circulating FFA level and uptake — toxic to ischemic myocardium

keaira
Download Presentation

Glucose-Insulin-Potassium (GIK) in AMI

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Glucose-Insulin-Potassium (GIK)in AMI

  2. Glucose-insulin-potassium “cocktail” Proposed mechanisms of benefit • Glucose (G)Energy efficiency of the heart—becomes preferred fuel • Insulin (I)Circulating FFA level and uptake—toxic to ischemic myocardium • Potassium (K)Depleted K levels in myocytes—lowers risk of ventricular arrhythmias CREATE-ECLA Trial Group Investigators. JAMA. 2005;293:437-46.

  3. GIK: Summary of early trials in AMI Odds ratio (99% CI) GIK better Placebo better 0.72 (0.57-0.90) P = 0.004 0 0.5 1 1.5 2 Fath-Ordoubadi F, Beatt KJ. Circulation. 1997;96:1152-6.

  4. Major trials of GIK in AMI Malmberg K et al. J Am Coll Cardiol. 1995. Malmberg K et al. Eur Heart J. 2005. CREATE-ECLA Trial Group Investigators. JAMA. 2005. *vs usual care

  5. DIGAMI 1: CVD mortality after AMI 0.7 0.7 Total cohort No insulin—low risk RRR = 28% RRR = 51% 0.6 0.6 P = 0.011 P = 0.004 0.5 0.5 n = 314 0.4 0.4 26% n = 306 Mortality n = 133 0.3 0.3 0.2 0.2 n = 139 19% 0.1 0.1 0 0 0 1 2 3 4 5 0 1 2 3 4 5 Years in study Control Insulin-glucose infusion CHF accounted for 66% of all deaths Malmberg K et al. BMJ. 1997;314:1512-15.Malmberg K et al. Eur Heart J. 1996;17:1337-44.

  6. Treatment groups had identical glucose control Results show long-term benefit in DIGAMI 1 is explained by better glucose control and not by GIK Not a glucose control trial Patients randomized irrespective of baseline glucose Mean glucose increased from baseline in GIK group DIGAMI 2 and CREATE-ECLA outcomes show need for glucose control DIGAMI 2 CREATE-ECLA Malmberg K et al. Eur Heart J. 2005. Van den Berghe G. Eur Heart J. 2005. CREATE-ECLA Trial Group Investigators. JAMA. 2005.

  7. CREATE-ECLA: Effect of GIK on mortality, glucose 200 12.0 † 187 GIK infusion 162 10.0 † 148 150 Control* 8.0 Mortality, cumulative events(%) Meanglucose(mg/dL) 100 6.0 4.0 50 2.0 0 0 Baseline(both groups) GIKgroup Control* 0 5 10 15 20 25 30 Days *Usual care only†6 hours after randomization CREATE-ECLA Trial Group Investigators. JAMA. 2005;293:437-46.

  8. CREATE-ECLA: Correlation of baseline glucose with mortality Control group, n = 10,107 Mortalityat 30 days (%) Glucose tertile CREATE-ECLA Trial Group Investigators. JAMA. 2005;293:437-46.

  9. “Regardless of its scientific rationale and the positive results of small studies, this definitive trial, combined with a previous overview that showed only a modest potential benefit, answers the question beyond reasonable doubt: there is no benefit of GIK therapy.” What CREATE-ECLA shows about GIK Califf RM. JAMA. 2005. CREATE-ECLA Trial Group Investigators. JAMA. 2005. Fath-Ordoubadi F, Beatt KJ. Circulation. 1997.

More Related