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David W. Quinn
Domenico Pagano
Robert S. Bonser
Stephen J. Rooney
Timothy R. Graham
Ian C. Wilson
Bruce E. Keogh
Michael E. Lewis
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Right arrow Cardiac - pharmacology
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J Thorac Cardiovasc Surg 2006;131:34-42
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Improved myocardial protection during coronary artery surgery with glucose-insulin-potassium: A randomized controlled trial

David W. Quinn, BSc, FRCS, Domenico Pagano, MD, FRCS, FESC, Robert S. Bonser, FRCP, FRCS, FESC * , * , Stephen J. Rooney, MB, FRCS, Timothy R. Graham, MB, FRCS, Ian C. Wilson, MD, FRCS, Bruce E. Keogh, MD, FRCS, John N. Townend, MD, FRCP, Michael E. Lewis, MD, FRCS, Peter Nightingale, PhD Study Investigators {ddagger}

Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, United Kingdom.

Received for publication March 14, 2005; revisions received May 11, 2005; accepted for publication May 26, 2005.

* Address for reprints: Robert S. Bonser, FRCP, FRCS, Consultant Cardiothoracic Surgeon, Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS trust, Edgbaston, Birmingham, UK, B15 2TH. (Email: robert.bonser{at}uhb.nhs.uk).

OBJECTIVE: We sought to assess the role of glucose-insulin-potassium in providing myocardial protection in nondiabetic patients undergoing coronary artery surgery with cardiopulmonary bypass.

METHODS: A prospective, randomized, double-blind, placebo-controlled trial was conducted at a single-center university hospital performing adult cardiac surgery. Two hundred eighty nondiabetic adult patients undergoing first-time elective or urgent isolated multivessel coronary artery bypass grafting were prospectively randomized to receive glucose-insulin-potassium infusion or placebo (dextrose 5%) before, during, and for 6 hours after surgical intervention. Anesthetic, cardiopulmonary bypass, myocardial protection, and surgical techniques were standardized. The primary end point was postreperfusion cardiac index. Secondary end points were systemic vascular resistance index, the incidence of low cardiac output episodes, inotrope and vasoconstrictor use, and biochemical-electrocardiographic evidence of myocardial injury. The incidence of dysrhythmias and infections requiring treatment was recorded prospectively.

RESULTS: The glucose-insulin-potassium group experienced higher cardiac indices (P < .001) throughout infusion and reduced vascular resistance (P < .001). The incidence of low cardiac output episodes was 15.9% (22/138) in the glucose-insulin-potassium group and 27.5% (39/142) in the placebo group (P = .021). Inotropes were required in 18.8% (26/138) of the glucose-insulin-potassium group and 40.8% (58/142) of the placebo group (P < .001). Fewer patients in the glucose-insulin-potassium group (12.3% [16/133]) versus those in the placebo group (23.4% [32/137]) had significant myocardial injury (P = .017). Noncardiac morbidity was not different.

CONCLUSION: Glucose-insulin-potassium therapy improves early postoperative cardiovascular performance, reduces inotrope requirement, and might reduce myocardial injury. These potential benefits are not at the expense of increased noncardiac morbidity.

Abbreviations and acronyms AF = atrial fibrillation; ANOVA = analysis of variance; CABG = coronary artery bypass grafting; CI = cardiac index; CPB = cardiopulmonary bypass; cTnI = cardiac troponin I; ECG = electrocardiogram; GIK = glucose-insulin-potassium; IQR = interquartile range; ITU = intensive therapy unit; LCOE = episodes of low cardiac output; NYHA = New York Heart Association; PMI = perioperative myocardial infarction; SD = standard deviation; SVR = systemic vascular resistance; SVRI = systemic vascular resistance index; WBG = whole blood glucose


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