Bradycardia: potassium, glucose and insulin increased survival.

Clinical bottom line (level 2b)

  1. Patients with heart block after myocardial infarction who were given potassium, glucose and insulin, were more likely to survive in the short term than those given placebo.
Mittra : Lancet 1966; : 1438-1441
Expires August 2003

The study

Retrospective cohort study with objective outcomes, ?adjusted for confounding factors, validated in an independent set of patients.
Setting: general hospital, UK

17 patients (aged range 54 to 74 years; mean 65, high-grade atrioventricular block (complete or second-degree block)
Control Group: (n = 8, 8 analysed): placebo
Experimental Group: (n = 9, 9 analysed): potassium , glucose , insulin given intravenously
Potassium, glucose and insulin were given i.v. to all patients with complete heart block and one patient with partial block; the rest of the patients received the potassium and glucose orally and the insulin subcutaneously.
100% followed for ? 11 to 22 months after discharge

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
death unknown 5
(62.5%)		 1
(11.1%)		 82.0%
(-22.0% to 97.0%)		 51.4%
(12.1% to 90.7%)		 2
(1 to 8)

Comments

  1. Unclear if this is a subgroup of a randomised trial, but appears to be a post-hoc analysis, whether randomised or not.

Citation

  1. Mittra B, : Potassium, glucose, and insulin in treatment of heart block after myocardial infarction. The Lancet 1966; : 1438-1441
Contributor: Clare Wotton and Bob Phillips, August 1999
Reviewer:

Clinical Question.
Patient heart block after myocardial infarction
Intervention or Exposure potassium, glucose and insulin
Comparison placebo
Outcome death