Format

Send to

Choose Destination
See comment in PubMed Commons below
Am J Cardiol. 2014 May 15;113(10):1599-605. doi: 10.1016/j.amjcard.2014.02.010. Epub 2014 Mar 1.

One-year outcomes of out-of-hospital administration of intravenous glucose, insulin, and potassium (GIK) in patients with suspected acute coronary syndromes (from the IMMEDIATE [Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency Care] Trial).

Author information

1
Center for Cardiovascular Health Services Research, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts. Electronic address: hselker@tuftsmedicalcenter.org.
2
Division of Cardiology and the CardioVascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
3
Department of Biostatistics, Boston University School of Medicine, Boston, Massachusetts.
4
Center for Cardiovascular Health Services Research, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
5
Department of Mathematics and Statistics, Boston University, Boston, Massachusetts.
6
Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts.
7
Division of Endocrinology, Diabetes and Metabolism, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
8
National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, Maryland.
9
Department of Medicine, University of Texas Southwestern Medical School, Dallas, Texas.
10
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
11
Department of Emergency Medicine, Cambridge Health Alliance, Cambridge, Massachusetts.
12
Alaska Regional Hospital, Department of Emergency Medicine, Anchorage, Alaska.
13
Department of Emergency Medicine, University of New Mexico Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, New Mexico.
14
Department of Emergency Medicine, University of New Mexico Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, New Mexico; Department of Anesthesiology, University of New Mexico Health Sciences Center, University of New Mexico School of Medicine, Albuquerque, New Mexico.
15
Department of Emergency Medicine, Medical Center of Central Georgia, Macon, Georgia.
16
Regions Hospital Emergency Medical Services, St. Paul, Minnesota.
17
Avera Medical Group, Sioux Falls, South Dakota.
18
Department of Emergency Medicine, Penn State Hershey Medical Center, Hershey, Pennsylvania.
19
Department of Emergency Medicine, Johnson Memorial Hospital, Stafford, Connecticut; Department of Emergency Medicine, Windham Community Memorial Hospital, Willimantic, Connecticut.
20
Department of Emergency Medicine, Emerson Hospital, Concord, Massachusetts.
21
Department of Emergency Medicine, Peace Health St. Joseph Medical Center, Bellingham, Washington.
22
Department of Emergency Medicine, Texas Tech University Health Sciences Center, El Paso, Texas.

Abstract

The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial of very early intravenous glucose-insulin-potassium (GIK) for acute coronary syndromes (ACS) in out-of-hospital emergency medical service (EMS) settings showed 80% reduction in infarct size at 30 days, suggesting potential longer-term benefits. Here we report 1-year outcomes. Prespecified 1-year end points of this randomized, placebo-controlled, double-blind, effectiveness trial included all-cause mortality and composites including cardiac arrest, mortality, or hospitalization for heart failure (HF). Of 871 participants randomized to GIK versus placebo, death occurred within 1 year in 11.6% versus 13.5%, respectively (unadjusted hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.57 to 1.23, p = 0.36). The composite of cardiac arrest or 1-year mortality was 12.8% versus 17.0% (HR 0.71, 95% CI 0.50 to 1.02, p = 0.06). The composite of hospitalization for HF or mortality within 1 year was 17.2% versus 17.2% (HR 0.98, 95% CI 0.70 to 1.37, p = 0.92). The composite of mortality, cardiac arrest, or HF hospitalization within 1 year was 18.1% versus 20.4% (HR 0.85, 95% CI 0.62 to 1.16, p = 0.30). In patients presenting with suspected ST elevation myocardial infarction, HRs for 1-year mortality and the 3 composites were, respectively, 0.65 (95% CI 0.33 to 1.27, p = 0.21), 0.52 (95% CI 0.30 to 0.92, p = 0.03), 0.63 (95% CI 0.35 to 1.16, p = 0.14), and 0.51 (95% CI 0.30 to 0.87, p = 0.01). In patients with suspected acute coronary syndromes, serious end points generally were lower with GIK than placebo, but the differences were not statistically significant. However, in those with ST elevation myocardial infarction, the composites of cardiac arrest or 1-year mortality, and of cardiac arrest, mortality, or HF hospitalization within 1 year, were significantly reduced.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00091507.

PMID:
24792735
PMCID:
PMC4043184
DOI:
10.1016/j.amjcard.2014.02.010
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center