Author/Authors :
Selker، نويسنده , , Harry P. and Udelson، نويسنده , , James E. and Massaro، نويسنده , , Joseph M. and Ruthazer، نويسنده , , Robin and DʹAgostino، نويسنده , , Ralph B. and Griffith، نويسنده , , John L. and Sheehan، نويسنده , , Patricia R. and Desvigne-Nickens، نويسنده , , Patrice and Rosenberg، نويسنده , , Yves and Tian، نويسنده , , Xin and Vickery، نويسنده , , Ellen M. and Atkins، نويسنده , , James M. and Aufderheide، نويسنده , , Tom P. and Sayah، نويسنده , , Assaad J. and Pirrallo، نويسنده , , Ronald G. and Levy، نويسنده , , Michael K. and Richards، نويسنده , , Michael E. and Braude، نويسنده , , Darren A. and Doyle، نويسنده , , Delanor D. and Frascone، نويسنده , , Ralph J. and Kosiak، نويسنده , , Donald J. and Leaming، نويسنده , , James M. and Van Gelder، نويسنده , , Carin M. and Walter، نويسنده , , Gert-Paul and Wayne، نويسنده , , Marvin A. and Woolard، نويسنده , , Robert H. and Beshansky، نويسنده , , Joni R.، نويسنده ,
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.
