Myocardial infarction: glucose-insulin-potassium regimes reduce mortality rates.

Clinical bottom line (level 1a)

  1. In patients with acute myocardial infarction, treatment with glucose-insulin-potassium infusions reduces mortality (NNT = 20 at 4 weeks) .
Fath-Ordoubadi and Beatt: Circulation 1997; 96 (4): 1152-1156
Expires March 2003

The study

Systematic review of all randomised controlled trials of
  • Patients: acute myocardial infarction without diabetes
  • Intervention: glucose-insulin-potassium therapy compared with placebo
  • Outcome: in-hospital mortality


Articles found in not stated using Medline, 1966 to 1996 (search terms: 'myocardial infarction' and descriptions of glucose-insulin-potassium therapies ) and scrutinising references

Selection criteria: as above
Appraisal criteria: not stated
Articles excluded if: inadequate randomisation (5), diabetic patients (1)

Nine studies were included, involving 1932 patients.
No significant heterogeneity was noted.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
in hospital mortality 4 weeks 205/976
(21.0%)		 0.72
(0.57 to 0.90) 		20
(13 to 59)

Comments

  1. The majority of studies were performed prior to thrombolysis and are of uncertain significance.
  2. Partial correction for failure to perform intention-to-treat analysis in original studies, but the remnant may increase the apparent effect.

Citation

  1. Fath-Ordoubadi F, and Beatt KJ: Glucose-Insulin-Potassium therapy for treatment of acute myocardial infarction: An overview of randomized placebo-controlled trials. Circulation 1997; 96 (4): 1152-1156
Contributor: Bob Phillips and Clare Wotton, November 1999
Reviewer:

Clinical Question.
Patient myocardial infarction without diabetes
Intervention or Exposure glucose-insulin-potassium infusions
Outcome mortality