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Abstract
Acute myocardial infarction (AMI) is the leading cause of death over the world. It is well established that diabetic patients have worse prognosis after AMI than those without diabetes. Inflammatory markers such as CRP reflect the extent of myocardial necrosis and correlate with cardiac outcomes following AMI. Glucose insulin infusion is a widely applicable, low- cost therapy that has been postulated to improve outcomes in patients with ST elevation myocardial infarction (STEMI).
Objective of the work:
The present study was conducted to determine the effect of glucose insulin infusion on high sensitivity C-reactive protein levels, left ventricular global systolic function, and cardiac adverse events in patients with ST segment elevation myocardial infarction during the early hospitalization period. . Patients and Methods:
This study included 60 patients admitted to the coronary care units of El-Sahel teaching hospital and Ain Shams University Hospitals with STEMI. All patients in this study were either known to have DM or hyperglycaemic on admission. All patients were candidates for thrombolytic therapy. They were divided into two groups. The glucose-insulin-potassium (GIK) group (30 patients) received glucose-insulin infusion according to a predefined protocol for 24 hours. The control group (30 patients) received subcutaneous soluble insulin every 8 hours according to a sliding scale. All patients included in the study were subjected to full history taking, thorough general and local examination, serial 12 lead resting ECGs, serial CK-MB levels and echocardiography. High sensitivity C- reactive protein was measured on admission and repeated 24 hours later.
Results:
There was no significant difference between the two groups regarding the sex distribution, mean age, prevalence of the different risk factors for coronary artery disease, duration and type of treatment of DM.
A- In-hospital adverse cardiac events: There was a significant statistical difference between the two groups regarding development of congestive heart failure (6.67% in the GIK group versus 26.67% in the control group, p<0.05).
B- Left ventricular systolic function: Ejection fraction was significantly higher in the GIK group than in the control group I (P < 0.05). In the GIK group, the mean ejection fraction (EF %) was 57.43% +8.34%, while in the control group, it was 51.17% +9.26%.
C- High sensitivity C-reactive protein: There was no significant difference regarding admission CRP between the two groups (P > 0.05). After 24 hours, CRP levels were significantly lower in the GIK group (15.22 +7.27) than that of the control group (34.45 +7.46), P < 0.001.
Conclusion:
GIK infusion in patients with ST segment elevation acute myocardial infarction showed beneficial effects as demonstrated by better preservation of the myocardial LV systolic function, lower rate of in-hospital development of congestive heart failure, and lower levels of C-reactive protein.