Glucose-insulin-potassium infusion for myocardial protection during off-pump coronary artery surgery

William A. Lell, Vance G Nielsen, David C. McGiffin, Frank E. Schmidt, James K. Kirklin, Alfred W. Stanley

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background. The purpose of this randomized, double-blind, placebo-controlled pilot study was to determine the effectiveness of an intravenous glucose-insulin-potassium (GIK) infusion in preventing myocardial damage and maintaining cardiac performance in patients undergoing "off-pump" myocardial revascularization. Methods. Forty-six adult patients undergoing elective off-pump coronary artery bypass received either normal saline or a GIK infusion immediately after the induction of anesthesia through the first 12 hours of intensive care unit convalescence. Measurements of blood glucose, circulating creatine kinase MB and troponin I concentrations, as well as cardiac index (CI) and mixed venous oxygen saturation (SvO2), were obtained immediately before starting the infusion (baseline) and at 6,12, and 24 hours post-initial coronary artery occlusion. Results. Five patients (8%) requiring cardiopulmonary bypass were excluded from data analysis. Twenty patients received saline. Twenty-one received GIK. Blood glucose was significantly higher in the GIK group. The concentration of circulating creatine kinase MB and troponin I significantly increased over time after off-pump coronary artery bypass, with no significant intergroup differences. Cardiac index and SvO2 did not differ significantly between groups. Conclusions. A GIK infusion protocol commonly used as an adjunct to reperfusion therapy for acute myocardial infarction causes insulin-resistant hyperglycemia in elective off-pump coronary artery bypass patients with no demonstrable benefit. The finding of significant release of cardio-specific enzymes in individual patients implies an ongoing need to develop more effective strategies for myocardial protection during off-pump coronary artery bypass.

Original languageEnglish (US)
Pages (from-to)1246-1251
Number of pages6
JournalAnnals of Thoracic Surgery
Volume73
Issue number4
DOIs
StatePublished - 2002
Externally publishedYes

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Off-Pump Coronary Artery Bypass
Coronary Vessels
Potassium
Insulin
Glucose
MB Form Creatine Kinase
Troponin I
Blood Glucose
Myocardial Revascularization
Coronary Occlusion
Cardiopulmonary Bypass
Hyperglycemia
Reperfusion
Intensive Care Units
Anesthesia
Myocardial Infarction
Placebos
Oxygen
Enzymes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Glucose-insulin-potassium infusion for myocardial protection during off-pump coronary artery surgery. / Lell, William A.; Nielsen, Vance G; McGiffin, David C.; Schmidt, Frank E.; Kirklin, James K.; Stanley, Alfred W.

In: Annals of Thoracic Surgery, Vol. 73, No. 4, 2002, p. 1246-1251.

Research output: Contribution to journalArticle

Lell, William A. ; Nielsen, Vance G ; McGiffin, David C. ; Schmidt, Frank E. ; Kirklin, James K. ; Stanley, Alfred W. / Glucose-insulin-potassium infusion for myocardial protection during off-pump coronary artery surgery. In: Annals of Thoracic Surgery. 2002 ; Vol. 73, No. 4. pp. 1246-1251.
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AU - Stanley, Alfred W.

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N2 - Background. The purpose of this randomized, double-blind, placebo-controlled pilot study was to determine the effectiveness of an intravenous glucose-insulin-potassium (GIK) infusion in preventing myocardial damage and maintaining cardiac performance in patients undergoing "off-pump" myocardial revascularization. Methods. Forty-six adult patients undergoing elective off-pump coronary artery bypass received either normal saline or a GIK infusion immediately after the induction of anesthesia through the first 12 hours of intensive care unit convalescence. Measurements of blood glucose, circulating creatine kinase MB and troponin I concentrations, as well as cardiac index (CI) and mixed venous oxygen saturation (SvO2), were obtained immediately before starting the infusion (baseline) and at 6,12, and 24 hours post-initial coronary artery occlusion. Results. Five patients (8%) requiring cardiopulmonary bypass were excluded from data analysis. Twenty patients received saline. Twenty-one received GIK. Blood glucose was significantly higher in the GIK group. The concentration of circulating creatine kinase MB and troponin I significantly increased over time after off-pump coronary artery bypass, with no significant intergroup differences. Cardiac index and SvO2 did not differ significantly between groups. Conclusions. A GIK infusion protocol commonly used as an adjunct to reperfusion therapy for acute myocardial infarction causes insulin-resistant hyperglycemia in elective off-pump coronary artery bypass patients with no demonstrable benefit. The finding of significant release of cardio-specific enzymes in individual patients implies an ongoing need to develop more effective strategies for myocardial protection during off-pump coronary artery bypass.

AB - Background. The purpose of this randomized, double-blind, placebo-controlled pilot study was to determine the effectiveness of an intravenous glucose-insulin-potassium (GIK) infusion in preventing myocardial damage and maintaining cardiac performance in patients undergoing "off-pump" myocardial revascularization. Methods. Forty-six adult patients undergoing elective off-pump coronary artery bypass received either normal saline or a GIK infusion immediately after the induction of anesthesia through the first 12 hours of intensive care unit convalescence. Measurements of blood glucose, circulating creatine kinase MB and troponin I concentrations, as well as cardiac index (CI) and mixed venous oxygen saturation (SvO2), were obtained immediately before starting the infusion (baseline) and at 6,12, and 24 hours post-initial coronary artery occlusion. Results. Five patients (8%) requiring cardiopulmonary bypass were excluded from data analysis. Twenty patients received saline. Twenty-one received GIK. Blood glucose was significantly higher in the GIK group. The concentration of circulating creatine kinase MB and troponin I significantly increased over time after off-pump coronary artery bypass, with no significant intergroup differences. Cardiac index and SvO2 did not differ significantly between groups. Conclusions. A GIK infusion protocol commonly used as an adjunct to reperfusion therapy for acute myocardial infarction causes insulin-resistant hyperglycemia in elective off-pump coronary artery bypass patients with no demonstrable benefit. The finding of significant release of cardio-specific enzymes in individual patients implies an ongoing need to develop more effective strategies for myocardial protection during off-pump coronary artery bypass.

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