Half of Heart Attack Victims May Be Saved on Way to Hospital by GIK Cocktail
Life-saving drugs in the hands of paramedics cost about $50; mixture of glucose, insulin, potassium
March 27, 2012 - Paramedics can reduce someone's chances of having a cardiac arrest or dying by 50 percent by immediately
administering a mixture of glucose, insulin and potassium ("GIK") to people having a heart attack, according to research presented today at
the American College of Cardiology's 61st Annual Scientific Session.
The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to
further advances in the field.
The study showed that patients who received GIK immediately after being diagnosed with acute coronary syndrome - which
indicates a heart attack is either in progress or on the way - were 50 percent less likely to have cardiac arrest (a condition in which the
heart suddenly stops beating) or die than those who received a placebo. Although, the treatment did not prevent the heart attack from
Over the first month following the event, patients who received GIK were 40 percent less likely to have cardiac arrest,
die or be hospitalized for heart failure.
The effect was even more striking for patients with ST-elevation heart attacks, which require immediate treatment. For
those patients, immediate GIK was associated with a 60 percent reduction in cardiac arrest or death.
"When started immediately in the home or on the way to the hospital - even before the diagnosis is completely established
- GIK appears to reduce the size of heart attacks and to reduce by half the risk of having a cardiac arrest or dying," said Harry P. Selker,
MD, MSPH, executive director of the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, who led the study with
Joni Beshansky, RN, MPH, co-principal investigator and project director.
"Acute coronary syndromes represent the largest cause of death in this country. GIK is a very inexpensive treatment that
appears to have promise in reducing those deaths and morbidity."
The cost of the treatment is about $50.
"Because the trial is the first to show GIK is effective when used by paramedics in real-world community settings, it
could have important implications for the treatment of heart attacks," Dr. Selker said.
Previous clinical trials have shown no consistent effect, likely because the GIK was given too late to help. This study,
the "IMMEDIATE Trial," was the first to test the effectiveness of administering GIK at the very first signs of a threatening heart attack, in
the community, rather than waiting hours until the diagnosis was well-established at a hospital, as done in previous clinical trials.
"We wanted to do something that is effective and can be used anywhere," said Dr. Selker. "We've done a lot of studies of
acute cardiac care in emergency departments and hospitals, but more people die of heart attacks outside the hospital than inside the hospital.
Hundreds of thousands of people per year are dying out in the community; we wanted to direct our attention to those patients."
The researchers trained paramedics in 36 Emergency Medical Services systems in 13 cities across the country to administer
GIK after determining that a patient was likely having a threatened or already established heart attack using electrocardiograph-based ACI-TIPI
(acute cardiac ischemia time-insensitive predictive instrument) and thrombolytic predictive instrument decision support that prints
patient-specific predictions on the top of an electrocardiogram.
The paramedics used these predictions to decide if a patient would likely benefit from treatment. There were 911 patients
randomized to receive either the GIK treatment or a placebo.
Administering GIK immediately also reduced the severity of the damage to the heart tissue from the heart attack. On
average, 2 percent of the heart tissue was destroyed by the heart attack in people receiving GIK, compared with 10 percent in those who
received the placebo.
Although a significant proportion of suspected heart attacks are later determined to be false alarms (23 percent in this
study), administering GIK does not appear to cause any harmful effects in such patients.
The research team will follow up with study participants at six and 12 months to evaluate the longer-term benefit of the
This study was funded by the NIH's National Heart, Lung and Blood Institute.
About the American College of Cardiology
The American College of Cardiology (http://www.cardiosource.org)
is a 40,000-member nonprofit medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice
managers. The College transforms cardiovascular care and improves heart health as it supports and advocates for quality improvement,
patient-centered care, payment innovation and professionalism. The ACC bestows credentials upon cardiovascular specialists who meet its
stringent qualifications and leads the formulation of health policy, standards and guidelines. It provides professional education, supports
and disseminates cardiovascular research, and operates national registries to measure and promote quality.
The ACC's Annual Scientific Session brings together cardiologists and cardiovascular specialists from around the world
each year to share the newest discoveries in treatment and prevention.
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