Intravenous glucose-insulin-potassium (GIK) have benefits in cardiac ischemic syndromes by providing metabolic support to ischemic myocardium.
Metabolic support could limit progression of unstable angina pectoris to myocardial infarction, lesson infarct size, and preserved left ventricular function.
The out of hospital administration of an infusion of glucose-insulin-potassium in patients with suspected acute myocardial infarction reduced the incidence of cardiac arrest or in-hospital mortality as well as infarct size (Selker HP et al).
Mortality has been demonstrated to be increased in patients with acute myocardial infarction who have admission and post admission glucose levels of greater than 140 mg/dL. (Goyal A et al).
GIK may prevent arrhythmias and cardiac arrest associated with ischemic related metabolic arrangements promoted by elevated free fatty acids during acute coronary syndromes.
GIK infusions should ideally be given early in the treatment, on presentation of acute coronary syndromes in an out of hospital setting rather than awaiting diagnosis of MI or STEMI at the hospital.
In a randomized, placebo-controlled, double-blind effectiveness trial intravenous GIK solution was administered by paramedics in a out of hospital setting one patients had a high probability of ACS: GIK compared with glucose placebo did not reduce progression to MI in suspected ACS patients, and was not associated with 30 day survival, but was associated with lower rates of outcome of cardiac arrest or in-hospital mortality (IMMEDIATE Randomized Controlled Trial).