1 From the Departments of Medicine and Pathology, University of California, San Diego, School of Medicine, Department of Medicine, La Jolla, California.
The effects of glucose-insulin-potassium (GIK) infusion and glucose (G) infusion started 30 min after experimental coronary occlusion and the combination of GIK and propranolol (P) started 3 hours after coronary occlusion on the development of myocardial infarction were studied in 37 dogs. Fifteen minutes after the coronary occlusion, epicardial electrocardiograms were recorded at 10-15 sites; 24 hours later transmural specimens were obtained from the same sites for determination of myocardial creatine phosphokinase (CPK) activity and the evaluation of morphologic changes. In the control group (normal saline infusion) the relationship between S-T-segment elevation (mv) 15 min after occlusion and CPK activity (IU/mg of protein) 24 hours later was: log CPK = –0.064 S-T + 1.24; r = 0.81. In the GIK group, the infusion was begun 15 min following epicardial mapping, and sites with the same S-T-segment elevations showed less CPK depression than did the control group: log CPK = –0.022 S-T + 1.25. The G group also showed less CPK depletion than the control group but to a somewhat lesser extent than the GIK group (log CPK = –0.030 S-T + 1.20). The group receiving GIK and P 3 hours after occlusion also showed less CPK depression than did the control group (log CPK = –0.034 S-T + 1.26). Histologic analysis in 24-hour specimens showed that sites which exhibited S-T-segment elevation 15 min after occlusion showed normal histology in 3% of specimens obtained from control dogs, while the other 97% showed early signs of myocardial infarction. However, in the GIK group, 36% of the specimens with S-T-segment elevation prior to the infusion were histologically normal 24 hours later, while in the G group 30% were normal, and in the GIK and P group 17% were normal. Electron microscopy confirmed the morphologic changes observed by light microscopy. Thus, in the presence of experimental coronary occlusion, GIK exerts a protective effect against myocardial ischemia and reduces the extent of myocardial necrosis. G alone acts similarly but to a lesser degree, while a beneficial effect can also be demonstrated when GIK and P are started 3 hours after the onset of coronary occlusion.
Submitted on September 7, 1971
© 1972 American Heart Association, Inc.
Effect of Glucose-Insulin-Potassium Infusion on Myocardial Infarction following Experimental Coronary Artery Occlusion
Key Words: Myocardial ischemic injury • Myocardial creatine phosphokinase • Anaerobic metabolism • S-T-segment elevation • Reversible myocardial injury • Reversible myocardial injury • Histologic signs of myocardial necrosis • Ultrastructural changes in myocardial necrosis • Propanolol • Beta-adrenergic blockade
Accepted on November 5, 1971
This article has been cited by other articles:
 |
|
 |
|
  R. A. Kloner and R. W. Nesto Glucose-Insulin-Potassium for Acute Myocardial Infarction: Continuing Controversy Over Cardioprotection Circulation, May 13, 2008; 117(19): 2523 - 2533. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Diaz, A. Goyal, S. R. Mehta, R. Afzal, D. Xavier, P. Pais, S. Chrolavicius, J. Zhu, K. Kazmi, L. Liu, et al. Glucose-Insulin-Potassium Therapy in Patients With ST-Segment Elevation Myocardial Infarction JAMA, November 28, 2007; 298(20): 2399 - 2405. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. L. Lujan, S. L. Britton, L. G. Koch, and S. E. DiCarlo Reduced susceptibility to ventricular tachyarrhythmias in rats selectively bred for high aerobic capacity Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2933 - H2941. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Quinn, D. Pagano, and R. S. Bonser Glucose and Insulin Influences on Heart and Brain in Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2005; 9(2): 173 - 178. [Abstract] [PDF]
|
|
|
|
 |
|
 C. S. Apstein and L. H. Opie A challenge to the metabolic approach to myocardial ischaemia Eur. Heart J., May 2, 2005; 26(10): 956 - 959. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. YELLON and J. M. DOWNEY Preconditioning the Myocardium: From Cellular Physiology to Clinical Cardiology Physiol Rev, October 1, 2003; 83(4): 1113 - 1151. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Yetkin, K. Senen, M. Ileri, R. Atak, B. Battaoglu, O. Yetkin, I. Tandogan, H. Turhan, and S. Cehreli Identification of Viable Myocardium in Patients with Chronic Coronary Artery Disease and Myocardial Dysfunction: Comparison of Low-Dose Dobutamine Stress Echocardiography and Echocardiography During Glucose-Insulin-Potassium Infusion Angiology, November 1, 2002; 53(6): 671 - 676. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Hynninen, M. A. Borger, V. Rao, R. D. Weisel, G. T. Christakis, J.-A. Carroll, and D. C. H. Cheng The Effect of Insulin Cardioplegia on Atrial Fibrillation After High-Risk Coronary Bypass Surgery: A Double-Blinded, Randomized, Controlled Trial Anesth. Analg., April 1, 2001; 92(4): 810 - 816. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Beauloye, L. Bertrand, U. Krause, A.-S. Marsin, T. Dresselaers, F. Vanstapel, J.-L. Vanoverschelde, and L. Hue No-Flow Ischemia Inhibits Insulin Signaling in Heart by Decreasing Intracellular pH Circ. Res., March 16, 2001; 88(5): 513 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. E. Sobel Acceleration of Restenosis by Diabetes : Pathogenetic Implications Circulation, March 6, 2001; 103(9): 1185 - 1187. [Full Text] [PDF]
|
|
|
|
 |
|
 H. L. Lazar, S. Chipkin, G. Philippides, Y. Bao, and C. Apstein Glucose-insulin-potassium solutions improve outcomes in diabetics who have coronary artery operations Ann. Thorac. Surg., July 1, 2000; 70(1): 145 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Zhu, L. Lu, Y. Xu, C. Greyson, and G. G. Schwartz Glucose-insulin-potassium preserves systolic and diastolic function in ischemia and reperfusion in pigs Am J Physiol Heart Circ Physiol, February 1, 2000; 278(2): H595 - H603. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. G Kleber ST-segment elevation in the electrocardiogram: a sign of myocardial ischemia Cardiovasc Res, January 1, 2000; 45(1): 111 - 118. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Depre, J.-L. J. Vanoverschelde, and H. Taegtmeyer Glucose for the Heart Circulation, February 2, 1999; 99(4): 578 - 588. [Full Text] [PDF]
|
|
|
|
 |
|
 H. L. Lazar, G. Philippides, C. Fitzgerald, D. Lancaster, R. J. Shemin, and C. Apstein GLUCOSE-INSULIN-POTASSIUM SOLUTIONS ENHANCE RECOVERY AFTER URGENT CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., February 1, 1997; 113(2): 354 - 362. [Abstract] [Full Text]
|
|
|
|
|
|
H. L. Lazar, X. Zhang, S. Rivers, S. Bernard, and R. J. Shemin Limiting Ischemic Myocardial Damage Using Glucose-Insulin-Potassium Solutions Ann. Thorac. Surg., August 1, 1995; 60(2): 411 - 416. [Abstract] [Full Text]
|
|
|
|
|
|
J. Darsinos, J. Karli, A. Pistevos, G. Levis, and S. Moulopoulos Hemodialysis with Calcium-Free Dialysate Prevents Myocardial Creatine Kinase Depletion After Brief Coronary Artery Occlusion in Dogs Angiology, January 1, 1988; 39(10): 865 - 872. [Abstract] [PDF]
|
|
|
|
|
|
F. A. Cecena-Seldner and J. Villarreal Effect of the Kallikrein Inhibitor Aprotinin on Myocardial Ischemia and Necrosis in Man Angiology, July 1, 1980; 31(7): 488 - 496. [Abstract] [PDF]
|
|
|
|
 |
|
 V. Caride and B. Zaret Liposome accumulation in regions of experimental myocardial infarction Science, November 18, 1977; 198(4318): 735 - 738. [Abstract] [PDF]
|
|
|
|
|
|
L. Gould, C.V.R. Reddy, and R. F. Gomprecht Cardiac Effects of Insulin, Glucose, and Potassium Angiology, October 1, 1975; 26(10): 740 - 748. [PDF]
|
|
|
|
|
|
R. J. Kones Cardiogenic Shock: Therapeutic Implications of Altered Myocardial Energy Balance Angiology, May 1, 1974; 25(5): 317 - 333. [PDF]
|
|