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Statewide Initiative Improves Time to Reperfusion in STEMI

Second study reports harmful effect of glucose-insulin-potassium infusion shortly after STEMI

TUESDAY, Nov. 27 (HealthDay News) -- A statewide campaign targeting the treatment of ST-segment elevation myocardial infarction (STEMI) improved average time to reperfusion, according to the results of a new study, and a second study reports the possible early harmful effect of glucose-insulin-potassium (GIK) infusions in patients with acute STEMI. Both studies are published in the Nov. 28 issue of the Journal of the American Medical Association.

James G. Jollis, M.D., of Duke University in Durham, N.C., and colleagues compared time to reperfusion in 2,089 patients with acute STEMI treated at 65 North Carolina hospitals three months prior to and three months after a quality implementation project. The intervention significantly improved door-to-device time in patients treated at percutaneous coronary intervention (PCI) hospitals and door-to-needle time in patients treated with thrombolysis at non-PCI hospitals.

Rafael Diaz, M.D., of the Etudios Cardiologica Latin America in Rosario, Argentina, and colleagues analyzed data from the OASIS-6 GIK trial, which randomized 2,748 patients with acute STEMI to receive either a GIK infusion or no infusion, as well as combined data on 22,943 patients with acute STEMI from the OASIS-6 and CREATE-ECLA GIK trials. The researchers found that in the combined trial results, the risk of death and composite death or heart failure was elevated in the first three days in patients receiving GIK, which may have been related to increased levels of glucose, potassium and net fluid gain post-infusion.

These results "have demonstrated that GIK infusion does not produce a favorable clinical effect in patients with STEMI. Moreover, GIK therapy appears to initially increase the rate of death postinfarction," Diaz and colleagues write.

The OASIS-6 trial was funded by Sanofi-Aventis, Organon, and GlaxoSmithKline.

Abstract - Jollis
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Abstract - Diaz
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