C-Reactive protein reactions to glucose-insulin-potassium infusion and relations to infarct size in patients with acute coronary syndromes

Hadeel Alkofide, Gordon S Huggins, Joni R Beshansky, Robin Ruthazer, Inga Peter, Madhab Ray, Jayanta T Mukherjee, Harry P Selker, Hadeel Alkofide, Gordon S Huggins, Joni R Beshansky, Robin Ruthazer, Inga Peter, Madhab Ray, Jayanta T Mukherjee, Harry P Selker

Abstract

Background: Some benefits of glucose-insulin-potassium (GIK) in patients with acute coronary syndromes (ACS) may be from an anti-inflammatory effect. The primary aim of this study was to assess the impact of GIK administration early in the course of ACS on inflammatory marker C-reactive protein (CRP) levels. A secondary aim was to investigate the association between CRP and 30-day infarct size.

Methods and results: Retrospective analysis of participants with ACS randomly assigned to GIK or placebo for at least 8 h in the IMMEDIATE Trial biological mechanism cohort (n = 143). High sensitivity CRP (hs-CRP) was measured at emergency department presentation, and 6 and 12 h into infusion. Logarithmically transformed hs-CRP values at 12-hours were lower with GIK vs. placebo (mean =0.65 mg/L in GIK, 0.84 mg/L in placebo), with a marginal trend toward significance (P = 0.053). Furthermore, using mixed models of hs-CRP, time, and study group, there was a significant increase in hs-CRP levels over time, but the rate of change did not differ between treatment arms (P = 0.3). Multivariable analysis showed that an elevation in hs-CRP, measured at 12 h, was an independent predictor of 30-day infarct size (β coefficient, 6.80; P = 0.04) using sestamibi SPECT imaging.

Conclusions: The results of this study show no significant effect of GIK on hs-CRP. In addition our results show that in patients with ACS, hs-CRP measured as early as 12 h can predict 30-day infarct size.

Trial registration: ClinicalTrials.gov NCT00091507.

Figures

Fig. 1
Fig. 1
hs-CRP Levels per Treatment Arm. Time course of mean ± SEM hs-CRP at initial, 6 h and 12 h per treatment arm. GIK indicates glucose-insulin-potassium; Hs-CRP high sensitivity C-reactive protein. *P = 0.053 between groups at 12 h (independent sample t-test). † P˂0.01 within group differences between initial and 6 h, 6 h and 12 h, and initial and 12 h (paired sample t-test). Initial time represents the first hs-CRP measurement (median = 2.5 h)

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