Metabolic Modulation as initially proposed by Sodi-Pallares continues to remain an attractive option for adjunctive therapy in Myocardial Infarction. Although PCI/CABG have greatly improved the standard of care in the post-thrombolytic era, they may not fully exploit the potential for myocardial salvage by themselves. GIK serves to delay cell death until reperfusion can occur and optimize energy transfer in the post-ischemic heart.
29 patients who sustained an Acute Myocardial Infarction were randomized to either Test or Control groups. In addition to standardized treatment, patients in the test group received High-dose Glucose-Insulin-Potassium infusion (Rackley Regime) while those in the control group received Normal-Saline. Apart from routine laboratory monitoring, levels of CK-MB were recorded at 0 & 24 hours. ST-segment scores, as measured by adding the total amount of ST elevation in mm in V1-V6 in Anterior Infarction & II-III-aVF in Inferior Infarction were also recorded at 0 & 24 hours. Complications relating to Angina, Arrhythmias, Heart-Failure, Biochemistry & other miscellaneous parameters were also recorded & compared amongst the 2 groups.
Serum Insulin levels rose at 24 hours in both groups, although levels were expectedly much higher amongst test subjects due to the GIK infusion. CK-MB levels fell significantly (p<0.05) at 24 hrs compared to controls amongst both diabetic & non-diabetic sub-populations in the test group. ST-segment scores declined significantly (p<0.05) amongst non-diabetics while showing an encouraging trend amongst the diabetics. Glucose & Potassium levels were well controlled in test subjects reflecting the balance achieved in the milieu interior. Incidences of arrhythmias & angina were significantly lower (p<0.05) in the test group, although they had no statistical bearing on overall mortality. Only 1 patient experienced transient hypoglycemia.
GIK salvages ischemic myocardium, reduces complications & paves the way for both pharmacological & physical reperfusion.
GIK is a cheap, reproducible & easily applicable adjunctive therapy devoid of the need for man-power or monitoring. With advances in Molecular & Cell-Biology techniques, Metabolic modulation has ample scope for research & implementation. Statistical Significance of Fall in CK-MB Levels (mg/dl) at 24 Hrs.Control GroupTest Group‘t Test’ ValuesNon Diabetics40.8 (SD = 65.95) n = 5-33.3 (SD = 46.20) n = 102.55; p < 0.05 *Diabetics50.28 (SD = 90.50) n = 7- 49 (SD = 63.791) n = 72.3; p < 0.05*Statistical Significance of Difference in ST Segment Scores at 24 Hrs.Control GroupTest Group‘t Test’ ValuesNon Diabetics- 1.4 (SD = 7.127) n = 5- 4.2 (SD = 2.201) n = 103.9024; p < 0.05*Diabetics- 2.42 (SD = 5.940) n = 7- 3.28 (SD = 2.870) n = 71.1713Distribution of In-Hospital Events with Statistical SignificanceEventControl GroupTest GroupChi Square TestAngina Reinfarction-2 (16.66%)2 (11.76%) -3.916, p<0.05*APC, VPC Bigeminy NSVT Ventricular Tachycardia Ventricular Fibrillation1 (8.33%) 1 (8.33%) -2 (16.66%) 1 (8.33%)--1 (5.88%) 1 (5.88%) -1.777CHF Cardiogenic Shock2 (16.66%) 1 (8.33%)2 (11.76%) -3.27Thromboembolic CVA-1 (5.88%)-Mortality4 (33.33%)2 (11.76%)2.5
p < 0.05 - Significant
A.S. Bachwani, None.