{"title":"大剂量葡萄糖-胰岛素-钾对接受再灌注治疗的急性冠状动脉综合征患者的影响：一项荟萃分析。","authors":"Zeyu Yang, Huiruo Liu, Dazhou Lu, Shengchuan Cao, Feng Xu, Chuanbao Li","doi":"10.5847/wjem.j.1920-8642.2024.048","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This meta-analysis aimed to assess the efficacy of high-dose glucose-insulin-potassium (GIK) therapy on clinical outcomes in acute coronary syndrome (ACS) patients receiving reperfusion therapy.</p><p><strong>Methods: </strong>We searched the PubMed, Web of Science, MEDLINE, Embase, and Cochrane Library databases from inception to April 26, 2022, for randomized controlled trials (RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy. The primary endpoint was major adverse cardiovascular events (MACEs).</p><p><strong>Results: </strong>Eleven RCTs with 884 patients were ultimately included. Compared with placebos, high-dose GIK markedly reduced MACEs (risk ratio [<i>RR</i>] 0.57, 95% confidence interval [95% <i>CI</i>]: 0.35 to 0.94, <i>P</i>=0.03) and the risk of heart failure (<i>RR</i> 0.48, 95% <i>CI</i>: 0.25 to 0.95, <i>P</i>=0.04) and improved the left ventricular ejection fraction (LVEF) (mean difference [<i>MD</i>] 2.12, 95% <i>CI</i>: 0.40 to 3.92, <i>P</i>=0.02) at 6 months. However, no difference was observed in all-cause mortality at 30 d or 1 year. Additionally, high-dose GIK was significantly associated with increased incidences of phlebitis (<i>RR</i> 4.78, 95% <i>CI</i>: 1.36 to 16.76, <i>P</i>=0.01), hyperglycemia (<i>RR</i> 9.06, 95% <i>CI</i>: 1.74 to 47.29, <i>P</i>=0.009) and hypoglycemia (<i>RR</i> 6.50, 95% <i>CI</i>: 1.28 to 33.01, <i>P</i>=0.02) but not reinfarction, hyperkalemia or secondary reperfusion. In terms of oxidative stress-lowering function, high-dose GIK markedly reduced superoxide dismutase (SOD) activity but not glutathione peroxidase (GSH-Px) or catalase (CAT) activity.</p><p><strong>Conclusion: </strong>Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering efficacy in response to high-dose GIK. Moreover, with a higher incidence of complications such as phlebitis, hyperglycemia, and hypoglycemia. Furthermore, there were no observed survival benefits associated with high-dose GIK. More trials with long-term follow-up are still needed.</p>","PeriodicalId":23685,"journal":{"name":"World journal of emergency medicine","volume":"15 3","pages":"181-189"},"PeriodicalIF":2.6000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11153375/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effects of high-dose glucose-insulin-potassium on acute coronary syndrome patients receiving reperfusion therapy: a meta-analysis.\",\"authors\":\"Zeyu Yang, Huiruo Liu, Dazhou Lu, Shengchuan Cao, Feng Xu, Chuanbao Li\",\"doi\":\"10.5847/wjem.j.1920-8642.2024.048\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This meta-analysis aimed to assess the efficacy of high-dose glucose-insulin-potassium (GIK) therapy on clinical outcomes in acute coronary syndrome (ACS) patients receiving reperfusion therapy.</p><p><strong>Methods: </strong>We searched the PubMed, Web of Science, MEDLINE, Embase, and Cochrane Library databases from inception to April 26, 2022, for randomized controlled trials (RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy. The primary endpoint was major adverse cardiovascular events (MACEs).</p><p><strong>Results: </strong>Eleven RCTs with 884 patients were ultimately included. Compared with placebos, high-dose GIK markedly reduced MACEs (risk ratio [<i>RR</i>] 0.57, 95% confidence interval [95% <i>CI</i>]: 0.35 to 0.94, <i>P</i>=0.03) and the risk of heart failure (<i>RR</i> 0.48, 95% <i>CI</i>: 0.25 to 0.95, <i>P</i>=0.04) and improved the left ventricular ejection fraction (LVEF) (mean difference [<i>MD</i>] 2.12, 95% <i>CI</i>: 0.40 to 3.92, <i>P</i>=0.02) at 6 months. However, no difference was observed in all-cause mortality at 30 d or 1 year. Additionally, high-dose GIK was significantly associated with increased incidences of phlebitis (<i>RR</i> 4.78, 95% <i>CI</i>: 1.36 to 16.76, <i>P</i>=0.01), hyperglycemia (<i>RR</i> 9.06, 95% <i>CI</i>: 1.74 to 47.29, <i>P</i>=0.009) and hypoglycemia (<i>RR</i> 6.50, 95% <i>CI</i>: 1.28 to 33.01, <i>P</i>=0.02) but not reinfarction, hyperkalemia or secondary reperfusion. In terms of oxidative stress-lowering function, high-dose GIK markedly reduced superoxide dismutase (SOD) activity but not glutathione peroxidase (GSH-Px) or catalase (CAT) activity.</p><p><strong>Conclusion: </strong>Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering efficacy in response to high-dose GIK. Moreover, with a higher incidence of complications such as phlebitis, hyperglycemia, and hypoglycemia. Furthermore, there were no observed survival benefits associated with high-dose GIK. More trials with long-term follow-up are still needed.</p>\",\"PeriodicalId\":23685,\"journal\":{\"name\":\"World journal of emergency medicine\",\"volume\":\"15 3\",\"pages\":\"181-189\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11153375/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World journal of emergency medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5847/wjem.j.1920-8642.2024.048\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World journal of emergency medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5847/wjem.j.1920-8642.2024.048","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
Effects of high-dose glucose-insulin-potassium on acute coronary syndrome patients receiving reperfusion therapy: a meta-analysis.
Background: This meta-analysis aimed to assess the efficacy of high-dose glucose-insulin-potassium (GIK) therapy on clinical outcomes in acute coronary syndrome (ACS) patients receiving reperfusion therapy.
Methods: We searched the PubMed, Web of Science, MEDLINE, Embase, and Cochrane Library databases from inception to April 26, 2022, for randomized controlled trials (RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy. The primary endpoint was major adverse cardiovascular events (MACEs).
Results: Eleven RCTs with 884 patients were ultimately included. Compared with placebos, high-dose GIK markedly reduced MACEs (risk ratio [RR] 0.57, 95% confidence interval [95% CI]: 0.35 to 0.94, P=0.03) and the risk of heart failure (RR 0.48, 95% CI: 0.25 to 0.95, P=0.04) and improved the left ventricular ejection fraction (LVEF) (mean difference [MD] 2.12, 95% CI: 0.40 to 3.92, P=0.02) at 6 months. However, no difference was observed in all-cause mortality at 30 d or 1 year. Additionally, high-dose GIK was significantly associated with increased incidences of phlebitis (RR 4.78, 95% CI: 1.36 to 16.76, P=0.01), hyperglycemia (RR 9.06, 95% CI: 1.74 to 47.29, P=0.009) and hypoglycemia (RR 6.50, 95% CI: 1.28 to 33.01, P=0.02) but not reinfarction, hyperkalemia or secondary reperfusion. In terms of oxidative stress-lowering function, high-dose GIK markedly reduced superoxide dismutase (SOD) activity but not glutathione peroxidase (GSH-Px) or catalase (CAT) activity.
Conclusion: Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering efficacy in response to high-dose GIK. Moreover, with a higher incidence of complications such as phlebitis, hyperglycemia, and hypoglycemia. Furthermore, there were no observed survival benefits associated with high-dose GIK. More trials with long-term follow-up are still needed.
期刊介绍：
The journal will cover technical, clinical and bioengineering studies related to multidisciplinary specialties of emergency medicine, such as cardiopulmonary resuscitation, acute injury, out-of-hospital emergency medical service, intensive care, injury and disease prevention, disaster management, healthy policy and ethics, toxicology, and sudden illness, including cardiology, internal medicine, anesthesiology, orthopedics, and trauma care, and more. The journal also features basic science, special reports, case reports, board review questions, and more. Editorials and communications to the editor explore controversial issues and encourage further discussion by physicians dealing with emergency medicine.
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