Glucose-Insulin-Potassium in Cardiac Surgery: A Meta-Analysis

doi:10.1016/j.athoracsur.2004.03.007

The Annals of Thoracic Surgery

Volume 78, Issue 5, November 2004, Pages 1650-1657

https://doi.org/10.1016/j.athoracsur.2004.03.007 Get rights and content

Abstract

Background

Glucose-insulin-potassium therapy (GIK) has been suggested to reduce mortality and improve postoperative recovery after cardiac surgery. We performed a meta-analysis of all randomized studies using GIK in cardiac surgery.

Methods

A systematic Medline search for all GIK studies in cardiac surgery was carried out. Randomized studies investigating the recovery of contractile function as a primary endpoint were included in the meta-analysis.

Results

Thirty-five GIK trials were identified. Twenty-four studies were excluded because of lack of randomization, supplementary administration of other substances, or due to other primary endpoints. Eleven studies were included with a total of 468 patients who underwent either coronary artery bypass grafting or heart valve replacement. Six studies noted a significant improvement in postoperative recovery. One study demonstrated no effect. In four studies, no comparable statistical analysis was available. GIK patients required similar or lesser doses of catecholamines. From the available data we estimated a weighted mean of relative improvement in postoperative recovery of cardiac index for GIK patients versus controls of 11.4%. Five of 11 studies reported the incidence of postoperative atrial fibrillation (AF). AF occurred in 23% (20/86) in GIK versus 42% (36/86) in control patients (p = 0.009).

Conclusions

The findings indicate that GIK may considerably improve postoperative recovery of contractile function and reduce the incidence of atrial arrhythmias after cardiac surgery. However, several factors limit the power of this analysis and large, randomized multicenter trials are needed to fully assess the efficacy of GIK after cardiac surgery.

Section snippets

Search Strategy

A systematic Medline search was performed using the search terms “cardiac surgery” and “heart surgery” and a set of terms for GIK: glucose, insulin, glucose-insulin, and glucose-insulin-potassium (GIK). We supplemented electronic searches by fact checking the reference lists provided by the studies selected and review articles on GIK therapy.

Inclusion and Exclusion Criteria

We included all randomized GIK studies in cardiac surgery that investigated the recovery of contractile function as a primary endpoint. We considered

Results

A total of 35 trials, conducted between 1970 and 2002, were identified 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40. Twenty-four studies were excluded 8, 9, 10, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40. Three studies were excluded because of lack of randomization 8, 10, 21, 1 because the data were collected retrospectively [32], 1 because aspartate and glutamate

Comment

We demonstrate in this analysis that GIK has the potential to considerably improve recovery of contractile function in patients after cardiac surgery. GIK is further effective in reducing the incidence of postoperative atrial fibrillation.

The first use of GIK in cardiac surgery was described in 1969. Braimbridge and associates [41] reported that GIK was successfully used to treat patients with low cardiac output not responding to isoprenaline, digoxin or pacemaking after triple-valve

Conclusion

We demonstrate in this analysis that GIK may considerably improve recovery of contractile function in patients after cardiac surgery. GIK may further be effective in reducing the incidence of postoperative atrial fibrillation. However, several factors limit the power of this analysis and large, randomized multicenter trials are required to fully assess the efficacy of GIK in cardiac surgery.

Acknowledgements

TD was supported by the Emmy Noether-Program of the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG, Do602/2). We wish to thank Dr Richard D. Weisel for helpful comments and suggestions.

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Original article: cardiovascularGlucose-Insulin-Potassium in Cardiac Surgery: A Meta-Analysis

Abstract

Background

Methods

Results

Conclusions

Section snippets

Search Strategy

Inclusion and Exclusion Criteria

Results

Comment

Conclusion

Acknowledgements

Am J Cardiol

Ann Thorac Surg

J Am Coll Cardiol

Ann Thorac Surg

J Thor Cardiovasc Surg

Am J Cardiol

Ann Thorac Surg

Ann Thorac Surg

J Cardiothorac Vasc Anaesth

Cardiovas Surg

J Thor Cardiovasc Surg

Ann Thorac Surg

J Thor Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thor Cardiovasc Surg

Ann Thorac Surg

J Cardiothorac Vasc Anesth

J Thor Cardiovasc Surg

Ann Thorac Surg

J Cardiothorac Vasc Anesth

Ann Thorac Surg

Ann Thorac Surg

J Thor Cardiovasc Surg

Lancet

Clin Med

Original article: cardiovascular
Glucose-Insulin-Potassium in Cardiac Surgery: A Meta-Analysis