A meta-analysis of glucose-insulin-potassium therapy for treatment of acute myocardial infarction

Abstract

Background: Glucose-insulin-potassium (GIK) therapy has been proposed to provide metabolic support to ischemic myocardium. A meta-analysis that included 1932 patients performed 10 years previously demonstrated that GIK therapy may have an important role in reducing mortality after acute myocardial infarction (AMI). Since then, many larger randomized trials investigating the role of GIK in the setting of AMI have been published; hence, the present study repeats the previous meta-analysis performed by the current authors to include these trials.

Method and results: A systematic MEDLINE search for all randomized, placebo-controlled studies of GIK therapy in the setting of AMI was conducted and a meta-analysis of the mortality data was performed. A total of 16 randomized trials from 1966 to 2008 were identified, with 28,374 patients included in the current meta-analysis. There was a total of 1367 deaths (9.6%) in the GIK group, with 1351 deaths (9.6%) in the control group. Meta-analysis did not reveal any benefit from GIK treatment (OR 1.0; 95% CI 0.9 to 1.1; P=0.9). Subgroup analysis of patients given high-dose GIK and in patients in whom reperfusion was not obtained did not demonstrate a benefit from GIK therapy.

Conclusion: A meta-analysis of 16 randomized trials that spanned 40 years and involved more than 28,000 patients did not reveal any mortality benefit for ST segment elevation AMI using GIK therapy when data from the modern thrombolysis/primary percutaneous coronary intervention era were included.

Keywords: Insulin; Meta-analysis; Myocardial infarction.

Figures

Figure 1)

Comparison of 30-day mortality outcome in patients treated with glucose-insulin-potassium (GIK) therapy. ORs and 95% CIs are presented for individual studies and pooled data. ECLA Estudios Cardiologicos Latinoamerica; GIPS Glucose-Insulin-Potassium Study; OASIS Organization for the Assessment of Strategies for Ischemic Syndromes trial; Pol-GIK Polish GIK trial

Figure 2)

Comparison of 30-day mortality outcome in patients treated with glucose-insulin-potassium (GIK) therapy. ORs and 95% CIs are presented for individual studies and pooled data. ECLA Estudios Cardiologicos Latinoamerica; GIPS Glucose-Insulin-Potassium Study; MRC Medical Research Council; OASIS Organization for the Assessment of Strategies for Ischemic Syndromes trial; Pol-GIK Polish GIK trial

Figure 3)

Comparison of 30-day mortality outcome in patients treated with glucose-insulin-potassium (GIK) therapy in whom reperfusion was not attained. ORs and 95% CIs are presented for individual studies and pooled data. ECLA Estudios Cardiologicos Latinoamerica; GIPS Glucose-Insulin-Potassium Study; MRC Medical Research Council; OASIS Organization for the Assessment of Strategies for Ischemic Syndromes trial

Figure 4)

Comparison of 30-day mortality outcome in patients treated with high-dose glucose-insulin-potassium (GIK) therapy. ORs and 95% CIs are presented for individual studies and pooled data. ECLA Estudios Cardiologicos Latinoamerica; GIPS Glucose-Insulin-Potassium Study; OASIS Organization for the Assessment of Strategies for Ischemic Syndromes trial