LIMITING ISCHEMIC MYOCARDIAL DAMAGE USING GLUCOSE-INSULIN-POTASSIUM SOLUTIONS

Background. This experimental study sought to determine whether the in fusion of glucose-insulin-potassium (GIK) solutions to ischemic myocar dium during revascularization would decrease myocardial damage. Method s. In 40 pigs, the second and third diagonal vessels were occluded wit h snares for 90 minutes followed by 30 minutes of cardioplegic arrest and 180 minutes of reperfusion. During the periods of coronary occlusi on and reperfusion, 10 pigs received GIK (glucose = 300 g/L, insulin = 50 U/L, K+ = 80 mEq/L) through the jugular vein at 1 mL . kg(-1) (.) h(-1) (GIK-IV group); 10 pigs received GIK through the coronary sinus (GIK-CS group); 5 pigs received GIK through the jugular vein during re perfusion only (GIK-R group); 5 pigs received GIK through the jugular vein 2 hours prior to coronary occlusion and then during the periods o f coronary occlusion and reperfusion (GIK-Pre group); and 10 pigs rece ived no GIK (Unmodified group). Ischemic damage was assessed by wall m otion scores using two-dimensional echocardiography, changes in myocar dial tissue pH, and the area of necrosis in the area of risk. Results. Hearts treated with GIK had significantly less tissue acidosis, highe r wall motion scores, and the least tissue necrosis (14% +/- 2% GIK-Pr e versus 12% +/- 2% GIK-CS versus 16% +/- 2% GIK-IV versus 25% +/- 2% GIK-R versus 73% +/- 4% Unmodified; all, p < 0.05 versus Unmodified). Conclusions. We conclude that a glucose-insulin-potassium solution red uces ischemic myocardial damage during coronary revascularization.