Effect of Glucose-Insulin-Potassium Infusion on Mortality in Patients With Acute ST-Segment Elevation Myocardial Infarction

Shamir R. Mehta,Salim Yusuf,Rafael Dı́az,Jun Zhu,Прем Пайс,Denis Xavier,Ernesto Paolasso,Rashid Ahmed,Changchun Xie,Khawar Kazmi, Javed Tai, Andrés Orlandini,Janice Pogue,Lisheng Liu, Lisa Cronin, Rajesh Gupta, Kaushik Haridas, T M Jaison, Prakash Joshi, P. G. Kerkar, Ajit K Maity, Subhash C. Manchanda, Sudhir Naik,Dorairaj Prabhakaran, Sridhar Reddy, Balwinder Singh, S Thanikachalam,Denis Xavier, Xiaofang Bai, T. Chen, Jinghan Cui, Ting Cui, Sun Fu, Hai Ge, Q. L. Li, S. M. Li, W. Li, Y. Q. Li,L. Liu, Y. H. Liu, Zhen Lu, Srividya P, DingXin-rong GongZhi-qing Qiao, Yong Song, Na Sun,L. H. Wang, S. W. Wang, W. Wang, Y. Wang, Na‐Qiong Wu, Yangsong Wu, Chaoyan Xu, Shuai Xu,Zesheng Xu, Guokai Yang, Huanyi Yang, C. Z. Zhang, S. T. Zhang, W. J. Zhang, Jinjun Zhou,Jun Zhu,Wael Almahmeed,Álvaro Avezum, P. Castro, R Corbalán, R. Pitarch Flors, B. M. Lombana, Lidia Marano,Darren K. McGuire, Ernesto Paolasso, J. E. Isea Perez,Leopoldo Soares Piegas,Frans Van de Werf,Harvey D. White,Mohammad Zubaid, Aradh Faruqi, Ishtiyaq Rasool, Khalida Soomro, Hasanul Banna,Salim Yusuf,Shamir R. Mehta, Rashid Ahmed, Sergey Pavlov,Janice Pogue,Feng Zhao, I. Tsuluca, M. Molec, I. Holadyk-Gris, Khansa Ahmed, Прем Пайс, D. Freeda, S. Lidwin, M Chenniappan, Beth Isaac, S. S. Iyengar, Prakash Joshi, Shriprakash Kalantri, S. K. Kaushik, U Mahorkar, J.Bhargava Narendra J.Bhargava Narendra, Sanjoy K. Paul, M.J. Santhosh, B.K.S. Sastry, S. B. Siwach, Kiron Varghese, Hongmei Yang, Yan Yang, X. Zhang,Huiqiong Tan, Jie Tang, X. Li, Lin Yan, Y. Zhang, J. Li, Matthew Bai, Yunlu Jiang, Siegfried Lang, Xiajun Shi, Zhu Tian, K. Wang, D. H. Yan, YU Shi-ying, Alejandro Pascual, H. Ozcoidi, C. Cuesta,Daniel Wojdyla, Gusztáv Font, M. I. Genisans, I. Chandna, Muhammad Rafiq, N. Dadani, Saira Fatima, Soheb Rehman, Syeda Ezz-e-Rukhshan Adil, K. Bhojomal, Adnan Hameed, Shahid Ali Khan,Peter Sleight,Colin Baigent, Jack Hirsh, W. Taylor, G. Tognoni, Peter Bacher, N. Bender, Udo F. Legler, U. Magin, U. Raschke, Mauro Melato, Mitermayer Brito, Alberto Alves de Lima, R. A. Ahuad Guerrero, Roberto A. Nordaby, Raúl Barcudi, Joseph De Bono, Rudrick Ledesma, Hugo R. Ramos, Alberto Caccavo, Stella M. Macı́n, S. N. Ferreyra Cantante, Guillermo D. Caime, L. Cartasegna, O. A. Perrino, A. J. Gambarte, Emanuele Marzetti, M. Garrido, R. J. Balado, Cristina Martínez, Andres Fernandez, Eduardo Ferro Queirel, J. O. Balbi, G. Amuchastegui, G Covelli, Antonella Gentile, C. E. Girino, José Gant López, Ricardo Pio Monti, Andrés Orlandini, Oscar A Pellizón, J. L. Ramos, Gerardo Zapata, Carlos Alberto Cuneo, J. A. Sanchez, Juan Pablo Albisu, Mario Berli, Miguel Hominal, Rossella Marino, V. Mezzina, Enrique M. Avila, P. Mascaró Baselga, Celia Castellanos, Héctor Luciardi, Lilia Luz Lobo Márquez, Juan Muntaner, Epotaménides Maria Good God, Gilmar Reis, Débora Miguel Soares,LC Bodanese, Euler Roberto Fernandes Manenti, Leonardo da Silva Prestes, José Geraldo de Castro Amino, RP Azevedo, Antônio Carlos Camargo Carvalho,Rui Fernando Ramos, Milton Alcaíno, Pablo Castro Gálvez, Ramón Corbalán Herreros, H. Liu, R. Wang, Zirui Liu, Xin Tian, G. Wang, Nan Zhang, J. Zhang, Clement C. Zai, W. Chen, Mingming Gao, Dayi Hu, Jia Si, D. X. Li, Q. Li,S. L. Liu, Yirui Sun, B. Wang, Guoqiang Xie, Zesheng Xu, Xinchun Yang, Mingjing Zhao, Xue-Qiao Zhao, Fang Zhang, S. Y. Liu, Zhouyong Ma, Yunlu Jiang, Zigang Zhen, Fei Huo, Hongmei Yang, Miao Yang, Chang-Hsu Yang, Xuexiu Chi, Z. X. Liu, Shunping Zhou, Fan Zhou, R. S. Guo, Jinliang Kong, Shaohua Ren, Jiayu Zhao, Hui Bai, Cheng Chen, Judy Cheng, Xudong Hao, H. Li, W. G. Li, S. Wang, W. Zhang,L. Li, Sun Fu, Jing Shao, Xiaoxue Tan, S. Chen, Jiao Fu, Qun Zheng, Jianxin Ma, H. Chen, Hongmei Ma, Lingli Gong, Z. Zhang, F. Li, Bing Yang, Lufang Zhou, Z. Wang, Xin Sun, Tao Gao, Q. Wang, Guo X, X. Wang, K. Zai, Qin Cui, Sarah Fan, W. Liu, Qingyan Meng, Qi Guo, Yuhan Qin, N. Wang, Geng Xu, Xu Yin, Q. Zhang, S. Zhang, R. Liu, F. Wang, W. K. Li, H. Zhang, Xiaodan Xu, Rashid Ma, Fang Xia Guan, Teng-Yao Yang, R. Zhqo, Jiyi Huang, A. Li, Jinjun Zhou, Xiang-Dong You, Lin Hao, F. Zhangfang, Xin‐Liang Ma, Chong Shen, Hui Zhu, N. F. Zho, Go Shine Huang, Peng Guo, Jin He Lou, Q. P. Wang, Xianjiao Jiang, Z. Li, Di Tian, Zhiyong Wu, Meihong Yang, Z. C. Li, Solmon Yang, Yan Tu, Chunhui He, Yin Cao, Young‐Min Han, Jiaqi Yang, Shanshan Dong, D. F. Li, Q. F. Zhang, Zhongjie Fan, Diogo An, J. Liu, Guokai Yang, Xiaodan Xu, Yezi Xia, Han Xu, T. Wang, D. Li, Wei Jiang, Paul Yang, C. Y. Liu, Shuyi Shang, Y. G. Zhang, E. Hernandez Leyva, Nuria Llontop Lopez, Aharon Medina, John Kanakakis, John N. Nanas, Panagiotis Papazoglou, Srinivas Jayaram, B. Srinivasulu, Saurabh S. Dani, Jayesh Prajapati, Gupta Dr.Deepak, James F Shallam, K. J. Nesaraj, Ashwani Kumar, Rajan Sharma, Sakthivel Balasubramaniyan, Chidambaram Narayanan, Rinku D Umrani, Sharad Chandra, S.K. Dwivedi, Ravi Kishore, Birendra Kumar, Y. Kumble, Sanjay Mehrotra, Pradipta Nayak, Saligram Srinivasaiah Ramesh, Pruthvi Shetty., Shailendra Trivedi, Rajveer Beniwal, Aditi Kalla, Raja Babu Panwar, Katia Alexander, A Bindu, Arun N. Nambiar, D. Barkavi, A. Kalanidhi, T.V.S. Pradeep, JB Rajesh, Mayur Ramesh, Saseendar Shanmugasundaram, Pawan Kumar, Gursukhmandeep Sidhu, R. B. Singh, K. N. Pradeep, Adarsh Mittal, J. B. Bijapure, M. Sudhakar Rao, N. G. Mohanarjun, M. Bhaskar Rao, B. Ramesh Babu, Neha E. H. Dinesh, Rajendra K. Jain, P. A. Jiwani, Sudhir Naik, T.N.C. Padmanabhan, Balasundar Raju, Ramkumar Soli Rajaram, Arhant Rao, D K M Rao, V. S.P. Rao, Shashank S. Sinha, Anil Bharani, Gagan Verma, Rohit Tongia, Sundeep Kalra, S C Sharma, Rahul Mehrotra, Sanjeev Sanghvi, O. P. Soni, Arunava Biswas, J. Boben, Giris Jacob, Jeffery Joseph, Aniket Puri, Vijay K. Puri, Harsimran Singh, Rajneesh Calton, G. K. Aneja, Prasanna Nyayadhish, Pratap Nathani, Santosh Rane, Mahesh Fulwani, Avanindra Jain, Ambreen Khan, Ramesh G. Salkar, Ayush Somani, Roshni Wadhwani, S. D. Zawar, Vinayak E Shegokar, Sudhir Tungikar, Vikrant Vijan, Rajiv Trehan, Aatish Garg, Somil Verma, Sunita Arun Borade, Divya Duggal, Jagdish Hiremath, Jagdish, V K Katyal, H. R. Devendrappa, Ratnakar, P. B. Latha, E. B. Manoj, P.P. Mohanan, P. Gandhimadhinathan, K. Jeremaiah, Behin Sundara Raj, R. Udaysankar, J. K. Chhaparwal, Sunil Thomas Chandy, Swatantra Gupta, Sridharan Raghavan, Priyamvadha Ramesh, Vanessa S Reddy, Pothur R. Srinivas, K. Divakar Rao, Bhaskara Rao Malipeddi, G.S.R. Murthy, RR Joshi, S. S. Patil, Stefano Tredici, Davide Agnelli, Emilio Assanelli, A. Bozzano, Luis Marsano, Roberta Crivello, A. Nejrotti, A. Abdulminem, Hisham Saad, Juan Martínez Sánchez, Jorge Calvillo, Angas Hamer, Hasanul Banna, Josep Ferré, Robert J. Freedman, N. Transk, Daniela B Almeida, P. J.C. Lujan, Cristina Mata, Carlos Gerardo Ramos Becerra, Karyll De J. Gonzalez, F Torres, Miguel A. Álvarez, Eli Carrillo

Yearbook of Cardiology（2005）

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摘要

Glucose-insulin-potassium (GIK) infusion is a widely applicable, low-cost therapy that has been postulated to improve mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Given the potential global importance of GIK infusion, a large, adequately powered randomized trial is required to determine the effect of GIK on mortality in patients with STEMI.To determine the effect of high-dose GIK infusion on mortality in patients with STEMI.Randomized controlled trial conducted in 470 centers worldwide among 20,201 patients with STEMI who presented within 12 hours of symptom onset. The mean age of patients was 58.6 years, and evidence-based therapies were commonly used.Patients were randomly assigned to receive GIK intravenous infusion for 24 hours plus usual care (n = 10,091) or to receive usual care alone (controls; n = 10,110).Mortality, cardiac arrest, cardiogenic shock, and reinfarction at 30 days after randomization.At 30 days, 976 control patients (9.7%) and 1004 GIK infusion patients (10.0%) died (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.95-1.13; P = .45). There were no significant differences in the rates of cardiac arrest (1.5% [151/10 107] in control and 1.4% [139/10,088] in GIK infusion; HR, 0.93; 95% CI, 0.74-1.17; P = .51), cardiogenic shock (6.3% [640/10 107] vs 6.6% [667/10 088]; HR, 1.05; 95% CI, 0.94-1.17; P = .38), or reinfarction (2.4% [246/10,107] vs 2.3% [236/10,088]; HR, 0.98; 95% CI, 0.82-1.17; P = .81). The rates of heart failure at 7 days after randomization were also similar between the groups (16.9% [1711/10,107] vs 17.1% [1721/10,088]; HR, 1.01; 95% CI, 0.95-1.08; P = .72). The lack of benefit of GIK infusion on mortality was consistent in prespecified subgroups, including in those with and without diabetes, in those presenting with and without heart failure, in those presenting early and later after symptom onset, and in those receiving and not receiving reperfusion therapy (thrombolysis or primary percutaneous coronary intervention).In this large, international randomized trial, high-dose GIK infusion had a neutral effect on mortality, cardiac arrest, and cardiogenic shock in patients with acute STEMI.

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myocardial infarct,potassium

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