The beneficial effect of insulin, glucose, and dipyridamole on regional left ventricular function early after acute myocardial infarction

Background High-dose glucose–insulin–potassium (GIK) solution has beneficial effects on reducing mortality in acute myocardial infarction. Dipyridamole (DIP) is a powerful antioxidant and increases adenosine concentration. Experimentally, GIK and DIP have additive protective effects in ischemia–reperfusion injury. Aim This work aims to assess the acute effects of DIP alone, GIK alone, and GIK+DIP on left ventricular function in patients evaluated early after an acute myocardial infarction. Methods Ten male patients (age 63±11 years) with uncomplicated acute myocardial infarction were evaluated within 3 days after admission. All had been treated with systemic thrombolysis and were on full therapy (including beta-blockers) at the time of testing. They underwent stress echocardiography [2D echo, with wall motion score index (WMSI) evaluated in a 16-segment model of the left ventricle, with each segment scored from 1=normal to 4=dyskinetic] during low-dose DIP alone (0.28 mg/kg in 4 min); GIK alone (4-h infusion of glucose 30%, 25 insulin units, and 40 mEq of KCl, at an infusion rate of 1.5 ml/kg/h); and GIK+DIP. Results Regional systolic function (baseline WMSI=1.69±0.2) improved after DIP (1.54±0.1), GIK (1.54±0.1), and, to a greater extent, after GIK+DIP (1.33±0.2; p<0.001 vs. baseline; p<0.05 vs. DIP; p<0.05 vs. GIK). Conclusion High-dose GIK has an acute beneficial effect on regional left ventricular function in patients with acute myocardial infarction. This beneficial effect is potentiated by low-dose DIP coadministration.