Solution does not reduce rate of progression to development of heart attack after chest pain
Patients experiencing symptoms such as chest pain who received from paramedics an intravenous solution consisting of glucose-insulin-potassium (GIK) had no reduction in the rate of progression to heart attack and no improvement in 30-day survival, although GIK was associated with a lower rate of the composite outcome of cardiac arrest or in-hospital death, according to a study appearing in JAMA. The study is being published early online to coincide with its presentation at the American College of Cardiology's annual scientific sessions.
Laboratory studies suggest that in the setting of cardiac ischemia, immediate intravenous GIK reduces ischemia-related arrhythmias and myocardial injury. "The potential benefit of GIK is thought to be related to timeliness of administration after onset of cardiac ischemia, especially for prevention of cardiac arrest, for which risk is highest the first hour of acute coronary syndromes [ACS; such as heart attack or unstable angina]/acute myocardial infarction [AMI; heart attack]. To date, clinical trials of GIK may have missed the opportunity to detect this effect because enrollment and treatment have awaited hospital diagnosis of MI, most often ST-elevation myocardial infarction [STEMI; a certain pattern on an electrocardiogram following a heart attack], hours after ischemic symptom onset and initial coronary occlusion [blockage]. To achieve the potential benefits related to early treatment, GIK ideally should be administered on presentation of ACS in the out-of-hospital setting rather than awaiting diagnosis of MI or STEMI at the hospital," according to background information in the article.
Harry P. Selker, M.D., M.S.P.H., of Tufts Medical Center and Tufts University School of Medicine, Boston, and colleagues conducted the Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care (IMMEDIATE) Trial, testing the effect of out-of-hospital emergency medical service (EMS) administration of GIK in the first hours of suspected ACS on progression to heart attack and on other outcomes including cardiac arrest, death, and heart failure (HF). The randomized, placebo-controlled trial was conducted in 13 U.S. cities (36 EMS agencies), from December 2006 through July 2011, in which paramedics, aided by electrocardiograph (ECG)-based decision support, randomized 911 (871 enrolled) patients with high probability of ACS. Participants were typical of patients presenting with suspected ACS and MI: average age was 63.6 years, 71 percent were men, and 86 percent presented with a chief complaint of chest pain. They were randomized a median (midpoint) of 90 minutes after ischemic symptom onset. Patients received intravenous GIK solution (n = 411) or identical-appearing 5 percent glucose placebo (n = 460) administered by paramedics in the out-of-hospital setting and continued for 12 hours.
The researchers found that for the primary end point of progression to heart attack, there was no statistically significant difference between patients in the GIK group (48.7 percent) vs. those in the placebo group (52.6 percent). For the major secondary end points, 30-day mortality was 4.4 percent with GIK vs. 6.1 percent with placebo; the composite end point of cardiac arrest or in-hospital mortality occurred in 4.4 percent with GIK vs. 8.7 percent with placebo.
Among patients who presented with ST-segment elevation on their initial out-of hospital ECG (163 who received GIK and 194 who received placebo), progression to MI occurred in 85.3 percent of those in the GIK group vs. 88.7 percent in the placebo group. Thirty-day mortality was 4.9 percent with GIK vs. 7.7 percent with placebo; the composite of cardiac arrest or in-hospital mortality occurred in 6.1 percent with GIK vs. 14.4 percent with placebo.
The researchers also found that for those treated within the first hour, there was no difference between the GIK and placebo groups in rates of progression to MI, although occurrence of the composite of cardiac arrest or in-hospital mortality was lower in the GIK group vs. the placebo group.
The authors suggest that among the possible reasons this trial suggested potential benefit for some outcomes for patients presenting with ST-segment elevation is that participants in the IMMEDIATE Trial were treated much earlier.
"Further studies are needed to assess the out-of-hospital use of GIK as therapy for patients with ACS."
More information: JAMA. 2012;307(18):doi:10.1001/jama.2012.426
Provided by JAMA and Archives Journals
- Adrenaline use in cardiac arrest Jul 26, 2011 | not rated yet | 0
- Study examines outcomes of erythropoietin use for heart attack patients undergoing PCI May 10, 2011 | not rated yet | 0
- Findings released from 1 of the largest percutaneous coronary intervention trials ever May 23, 2008 | not rated yet | 0
- Drug does not appear to reduce risk of heart attack or death following CABG surgery Apr 01, 2008 | not rated yet | 0
- New resuscitation approach for out-of-hospital cardiac arrest associated with increased survival Mar 11, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
The Durability of Bone: Long Falls
1 hour ago I am doing a paper on the physics in Valve's Portal and got interested in the "Long Fall Boots" that prevent any damage no matter how far you fall. I...
Is energy convertible to matter?
3 hours ago Can we convert energy to matter?
Rotating electron as a dipole is this right?
5 hours ago An electron as shown by the Stern Gerlach experiment behaves like a dipole (albeit only in one of two states). I have been trying to figure out how...
Dipole term in multipole expansion
9 hours ago Hi. I'm having some difficult in understanding something about the dipole term in a multipole expansion. Griffiths writes the expansion as a sum of...
Bubbles in a Pre-Boiling/Boiling pot of water
11 hours ago How is it that bubbles form on the bottom of a surface of a pot of boiling water? I think that there is probably an elementary answer to this...
Assumptions of Griffith's fracture theory
21 hours ago Any experts on Griffith's fracture theory? I am studying the subject and I am having hard time finding out if the theory is valid for all possible...
- More from Physics Forums - Classical Physics
More news stories
The Orsiro stent, which is a novel stent platform eluting sirolimus from a biodegradable polymer, demonstrated non-inferiority to the Xience Prime everolimus-eluting stent for the primary angiographic endpoint of in-stent ...
Cardiology 6 hours ago | not rated yet | 0
One-year results from SOURCE XT – one of the largest, post-approval transcatheter aortic valve implantation (TAVI) registries to-date – reported today at EuroPCR 2013 show good clinical outcomes in routine clinical practice, ...
Cardiology 6 hours ago | not rated yet | 0
A drug commonly used to treat depression and anxiety may improve a stress-related heart condition in people with stable coronary heart disease, according to researchers at Duke Medicine.
Cardiology 7 hours ago | not rated yet | 0 |
(Medical Xpress)—In a recent subgroup analysis of the largest blood pressure treatment trial in history, University of Alabama at Birmingham (UAB) researchers found that women and men react the same to ...
Cardiology 15 hours ago | 5 / 5 (1) | 0
(Medical Xpress)—Native peoples in regions where cameras are uncommon sometimes react with caution when their picture is taken. The fear that something must have been stolen from them to create the photo ...
12 hours ago | 4.2 / 5 (5) | 0 |
(Medical Xpress)—Despite spending billions of dollars on research and development, drug companies have been unable to come up with effective treatments for dementia and Alzheimer's Disease (AD). Now, A. ...
10 hours ago | 4.9 / 5 (9) | 0 |
Activating an enzyme known to play a role in the anti-aging benefits of calorie restriction delays the loss of brain cells and preserves cognitive function in mice, according to a study published in the May ...
6 hours ago | 5 / 5 (3) | 0 |
An experimental sleeping pill from US drug company Merck is effective at helping people fall and stay asleep, according to reviewers at the US Food and Drug Administration, which could soon approve the new drug.
5 hours ago | 3 / 5 (2) | 0
Australian scientists have charted the path of insulin action in cells in precise detail like never before. This provides a comprehensive blueprint for understanding what goes wrong in diabetes.
12 hours ago | 4.4 / 5 (5) | 0 |
Researchers at USC have found that a class of pharmaceuticals can both prevent and treat Alzheimer's Disease in mice.
9 hours ago | 5 / 5 (3) | 0 |