One-year outcomes of out-of-hospital administration of intravenous glucose, insulin, and potassium (GIK) in patients with suspected acute coronary syndromes (from the IMMEDIATE [Immediate Myocardial Metabolic Enhancement during Initial Assessment and Treatment in Emergency Care] Trial)

Harry P. Selker, James E. Udelson, Joseph M. Massaro, Robin Ruthazer, Ralph B. D'Agostino, John L. Griffith, Patricia R. Sheehan, Patrice Desvigne-Nickens, Yves Rosenberg, Xin Tian, Ellen M. Vickery, James M Atkins, Tom P. Aufderheide, Assaad J. Sayah, Ronald G. Pirrallo, Michael K. Levy, Michael E. Richards, Darren A. Braude, Delanor D. Doyle, Ralph J. FrasconeDonald J. Kosiak, James M. Leaming, Carin M. Van Gelder, Gert Paul Walter, Marvin A. Wayne, Robert H. Woolard, Joni R. Beshansky

Research output: Contribution to journalArticle

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Abstract

The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial of very early intravenous glucose-insulin-potassium (GIK) for acute coronary syndromes (ACS) in out-of-hospital emergency medical service (EMS) settings showed 80% reduction in infarct size at 30 days, suggesting potential longer-term benefits. Here we report 1-year outcomes. Prespecified 1-year end points of this randomized, placebo-controlled, double-blind, effectiveness trial included all-cause mortality and composites including cardiac arrest, mortality, or hospitalization for heart failure (HF). Of 871 participants randomized to GIK versus placebo, death occurred within 1 year in 11.6% versus 13.5%, respectively (unadjusted hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.57 to 1.23, p = 0.36). The composite of cardiac arrest or 1-year mortality was 12.8% versus 17.0% (HR 0.71, 95% CI 0.50 to 1.02, p = 0.06). The composite of hospitalization for HF or mortality within 1 year was 17.2% versus 17.2% (HR 0.98, 95% CI 0.70 to 1.37, p = 0.92). The composite of mortality, cardiac arrest, or HF hospitalization within 1 year was 18.1% versus 20.4% (HR 0.85, 95% CI 0.62 to 1.16, p = 0.30). In patients presenting with suspected ST elevation myocardial infarction, HRs for 1-year mortality and the 3 composites were, respectively, 0.65 (95% CI 0.33 to 1.27, p = 0.21), 0.52 (95% CI 0.30 to 0.92, p = 0.03), 0.63 (95% CI 0.35 to 1.16, p = 0.14), and 0.51 (95% CI 0.30 to 0.87, p = 0.01). In patients with suspected acute coronary syndromes, serious end points generally were lower with GIK than placebo, but the differences were not statistically significant. However, in those with ST elevation myocardial infarction, the composites of cardiac arrest or 1-year mortality, and of cardiac arrest, mortality, or HF hospitalization within 1 year, were significantly reduced.

Original languageEnglish (US)
Pages (from-to)1599-1605
Number of pages7
JournalAmerican Journal of Cardiology
Volume113
Issue number10
DOIs
StatePublished - May 15 2014

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Hospital Administration
Emergency Medical Services
Acute Coronary Syndrome
Potassium
Confidence Intervals
Insulin
Glucose
Heart Arrest
Mortality
Heart Failure
Hospitalization
Placebos
Therapeutics
Hospital Emergency Service

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

One-year outcomes of out-of-hospital administration of intravenous glucose, insulin, and potassium (GIK) in patients with suspected acute coronary syndromes (from the IMMEDIATE [Immediate Myocardial Metabolic Enhancement during Initial Assessment and Treatment in Emergency Care] Trial). / Selker, Harry P.; Udelson, James E.; Massaro, Joseph M.; Ruthazer, Robin; D'Agostino, Ralph B.; Griffith, John L.; Sheehan, Patricia R.; Desvigne-Nickens, Patrice; Rosenberg, Yves; Tian, Xin; Vickery, Ellen M.; Atkins, James M; Aufderheide, Tom P.; Sayah, Assaad J.; Pirrallo, Ronald G.; Levy, Michael K.; Richards, Michael E.; Braude, Darren A.; Doyle, Delanor D.; Frascone, Ralph J.; Kosiak, Donald J.; Leaming, James M.; Van Gelder, Carin M.; Walter, Gert Paul; Wayne, Marvin A.; Woolard, Robert H.; Beshansky, Joni R.

In: American Journal of Cardiology, Vol. 113, No. 10, 15.05.2014, p. 1599-1605.

Research output: Contribution to journalArticle

Selker, HP, Udelson, JE, Massaro, JM, Ruthazer, R, D'Agostino, RB, Griffith, JL, Sheehan, PR, Desvigne-Nickens, P, Rosenberg, Y, Tian, X, Vickery, EM, Atkins, JM, Aufderheide, TP, Sayah, AJ, Pirrallo, RG, Levy, MK, Richards, ME, Braude, DA, Doyle, DD, Frascone, RJ, Kosiak, DJ, Leaming, JM, Van Gelder, CM, Walter, GP, Wayne, MA, Woolard, RH & Beshansky, JR 2014, 'One-year outcomes of out-of-hospital administration of intravenous glucose, insulin, and potassium (GIK) in patients with suspected acute coronary syndromes (from the IMMEDIATE [Immediate Myocardial Metabolic Enhancement during Initial Assessment and Treatment in Emergency Care] Trial)', American Journal of Cardiology, vol. 113, no. 10, pp. 1599-1605. https://doi.org/10.1016/j.amjcard.2014.02.010
Selker, Harry P. ; Udelson, James E. ; Massaro, Joseph M. ; Ruthazer, Robin ; D'Agostino, Ralph B. ; Griffith, John L. ; Sheehan, Patricia R. ; Desvigne-Nickens, Patrice ; Rosenberg, Yves ; Tian, Xin ; Vickery, Ellen M. ; Atkins, James M ; Aufderheide, Tom P. ; Sayah, Assaad J. ; Pirrallo, Ronald G. ; Levy, Michael K. ; Richards, Michael E. ; Braude, Darren A. ; Doyle, Delanor D. ; Frascone, Ralph J. ; Kosiak, Donald J. ; Leaming, James M. ; Van Gelder, Carin M. ; Walter, Gert Paul ; Wayne, Marvin A. ; Woolard, Robert H. ; Beshansky, Joni R. / One-year outcomes of out-of-hospital administration of intravenous glucose, insulin, and potassium (GIK) in patients with suspected acute coronary syndromes (from the IMMEDIATE [Immediate Myocardial Metabolic Enhancement during Initial Assessment and Treatment in Emergency Care] Trial). In: American Journal of Cardiology. 2014 ; Vol. 113, No. 10. pp. 1599-1605.
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abstract = "The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial of very early intravenous glucose-insulin-potassium (GIK) for acute coronary syndromes (ACS) in out-of-hospital emergency medical service (EMS) settings showed 80{\%} reduction in infarct size at 30 days, suggesting potential longer-term benefits. Here we report 1-year outcomes. Prespecified 1-year end points of this randomized, placebo-controlled, double-blind, effectiveness trial included all-cause mortality and composites including cardiac arrest, mortality, or hospitalization for heart failure (HF). Of 871 participants randomized to GIK versus placebo, death occurred within 1 year in 11.6{\%} versus 13.5{\%}, respectively (unadjusted hazard ratio [HR] 0.83, 95{\%} confidence interval [CI] 0.57 to 1.23, p = 0.36). The composite of cardiac arrest or 1-year mortality was 12.8{\%} versus 17.0{\%} (HR 0.71, 95{\%} CI 0.50 to 1.02, p = 0.06). The composite of hospitalization for HF or mortality within 1 year was 17.2{\%} versus 17.2{\%} (HR 0.98, 95{\%} CI 0.70 to 1.37, p = 0.92). The composite of mortality, cardiac arrest, or HF hospitalization within 1 year was 18.1{\%} versus 20.4{\%} (HR 0.85, 95{\%} CI 0.62 to 1.16, p = 0.30). In patients presenting with suspected ST elevation myocardial infarction, HRs for 1-year mortality and the 3 composites were, respectively, 0.65 (95{\%} CI 0.33 to 1.27, p = 0.21), 0.52 (95{\%} CI 0.30 to 0.92, p = 0.03), 0.63 (95{\%} CI 0.35 to 1.16, p = 0.14), and 0.51 (95{\%} CI 0.30 to 0.87, p = 0.01). In patients with suspected acute coronary syndromes, serious end points generally were lower with GIK than placebo, but the differences were not statistically significant. However, in those with ST elevation myocardial infarction, the composites of cardiac arrest or 1-year mortality, and of cardiac arrest, mortality, or HF hospitalization within 1 year, were significantly reduced.",
author = "Selker, {Harry P.} and Udelson, {James E.} and Massaro, {Joseph M.} and Robin Ruthazer and D'Agostino, {Ralph B.} and Griffith, {John L.} and Sheehan, {Patricia R.} and Patrice Desvigne-Nickens and Yves Rosenberg and Xin Tian and Vickery, {Ellen M.} and Atkins, {James M} and Aufderheide, {Tom P.} and Sayah, {Assaad J.} and Pirrallo, {Ronald G.} and Levy, {Michael K.} and Richards, {Michael E.} and Braude, {Darren A.} and Doyle, {Delanor D.} and Frascone, {Ralph J.} and Kosiak, {Donald J.} and Leaming, {James M.} and {Van Gelder}, {Carin M.} and Walter, {Gert Paul} and Wayne, {Marvin A.} and Woolard, {Robert H.} and Beshansky, {Joni R.}",
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T1 - One-year outcomes of out-of-hospital administration of intravenous glucose, insulin, and potassium (GIK) in patients with suspected acute coronary syndromes (from the IMMEDIATE [Immediate Myocardial Metabolic Enhancement during Initial Assessment and Treatment in Emergency Care] Trial)

AU - Selker, Harry P.

AU - Udelson, James E.

AU - Massaro, Joseph M.

AU - Ruthazer, Robin

AU - D'Agostino, Ralph B.

AU - Griffith, John L.

AU - Sheehan, Patricia R.

AU - Desvigne-Nickens, Patrice

AU - Rosenberg, Yves

AU - Tian, Xin

AU - Vickery, Ellen M.

AU - Atkins, James M

AU - Aufderheide, Tom P.

AU - Sayah, Assaad J.

AU - Pirrallo, Ronald G.

AU - Levy, Michael K.

AU - Richards, Michael E.

AU - Braude, Darren A.

AU - Doyle, Delanor D.

AU - Frascone, Ralph J.

AU - Kosiak, Donald J.

AU - Leaming, James M.

AU - Van Gelder, Carin M.

AU - Walter, Gert Paul

AU - Wayne, Marvin A.

AU - Woolard, Robert H.

AU - Beshansky, Joni R.

PY - 2014/5/15

Y1 - 2014/5/15

N2 - The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial of very early intravenous glucose-insulin-potassium (GIK) for acute coronary syndromes (ACS) in out-of-hospital emergency medical service (EMS) settings showed 80% reduction in infarct size at 30 days, suggesting potential longer-term benefits. Here we report 1-year outcomes. Prespecified 1-year end points of this randomized, placebo-controlled, double-blind, effectiveness trial included all-cause mortality and composites including cardiac arrest, mortality, or hospitalization for heart failure (HF). Of 871 participants randomized to GIK versus placebo, death occurred within 1 year in 11.6% versus 13.5%, respectively (unadjusted hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.57 to 1.23, p = 0.36). The composite of cardiac arrest or 1-year mortality was 12.8% versus 17.0% (HR 0.71, 95% CI 0.50 to 1.02, p = 0.06). The composite of hospitalization for HF or mortality within 1 year was 17.2% versus 17.2% (HR 0.98, 95% CI 0.70 to 1.37, p = 0.92). The composite of mortality, cardiac arrest, or HF hospitalization within 1 year was 18.1% versus 20.4% (HR 0.85, 95% CI 0.62 to 1.16, p = 0.30). In patients presenting with suspected ST elevation myocardial infarction, HRs for 1-year mortality and the 3 composites were, respectively, 0.65 (95% CI 0.33 to 1.27, p = 0.21), 0.52 (95% CI 0.30 to 0.92, p = 0.03), 0.63 (95% CI 0.35 to 1.16, p = 0.14), and 0.51 (95% CI 0.30 to 0.87, p = 0.01). In patients with suspected acute coronary syndromes, serious end points generally were lower with GIK than placebo, but the differences were not statistically significant. However, in those with ST elevation myocardial infarction, the composites of cardiac arrest or 1-year mortality, and of cardiac arrest, mortality, or HF hospitalization within 1 year, were significantly reduced.

AB - The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial of very early intravenous glucose-insulin-potassium (GIK) for acute coronary syndromes (ACS) in out-of-hospital emergency medical service (EMS) settings showed 80% reduction in infarct size at 30 days, suggesting potential longer-term benefits. Here we report 1-year outcomes. Prespecified 1-year end points of this randomized, placebo-controlled, double-blind, effectiveness trial included all-cause mortality and composites including cardiac arrest, mortality, or hospitalization for heart failure (HF). Of 871 participants randomized to GIK versus placebo, death occurred within 1 year in 11.6% versus 13.5%, respectively (unadjusted hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.57 to 1.23, p = 0.36). The composite of cardiac arrest or 1-year mortality was 12.8% versus 17.0% (HR 0.71, 95% CI 0.50 to 1.02, p = 0.06). The composite of hospitalization for HF or mortality within 1 year was 17.2% versus 17.2% (HR 0.98, 95% CI 0.70 to 1.37, p = 0.92). The composite of mortality, cardiac arrest, or HF hospitalization within 1 year was 18.1% versus 20.4% (HR 0.85, 95% CI 0.62 to 1.16, p = 0.30). In patients presenting with suspected ST elevation myocardial infarction, HRs for 1-year mortality and the 3 composites were, respectively, 0.65 (95% CI 0.33 to 1.27, p = 0.21), 0.52 (95% CI 0.30 to 0.92, p = 0.03), 0.63 (95% CI 0.35 to 1.16, p = 0.14), and 0.51 (95% CI 0.30 to 0.87, p = 0.01). In patients with suspected acute coronary syndromes, serious end points generally were lower with GIK than placebo, but the differences were not statistically significant. However, in those with ST elevation myocardial infarction, the composites of cardiac arrest or 1-year mortality, and of cardiac arrest, mortality, or HF hospitalization within 1 year, were significantly reduced.

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