Document Detail


Effect of perioperative glucose-insulin-potassium infusions on mortality and atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis.
MedLine Citation:
PMID:  20548978     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Glucose-insulin infusions (with potassium [GIK] or without [GI]) have been advocated in the setting of coronary artery bypass graft (CABG) surgery to optimize myocardial glucose use and to minimize ischemic injury.
OBJECTIVE: To conduct a meta-analysis assessing whether the use of GIKGI infusions perioperatively reduce in-hospital mortality or atrial fibrillation (AF) after CABG surgery.
METHODS: Electronic databases (Medline, EMBASE and Cochrane Central Register of Controlled Trials [CENTRAL]) and references of retrieved articles were searched for randomized controlled trials that evaluated the effects of GIK or GI infusions, before or during CABG surgery, on in-hospital mortality andor postoperative AF. Pooled ORs and 95% CIs were calculated for each outcome.
RESULTS: Twenty trials were identified and eligible for review. The summary OR for in-hospital mortality was 0.88 (95% CI 0.56 to 1.40), based on 44 deaths among 2326 patients. While postoperative AF was a more frequent outcome (occurring in 519 of 1540 patients in the 10 trials reporting this outcome), the overall pooled estimate of effect was nonsignificant (OR 0.79, 95% CI 0.54 to 1.15). This latter finding needs to be interpreted cautiously because it is accompanied by significant heterogeneity across trials.
CONCLUSIONS: Perioperative use of GIKGI does not significantly reduce mortality or atrial fibrillation in patients undergoing CABG surgery. Unless future trial data in support of GIKGI infusions become available, the routine use of these treatments in patients undergoing CABG surgery should be discouraged because the safety of these infusions has not been systematically examined.
Authors:
Doreen Rabi; Fiona Clement; Finlay McAlister; Sumit Majumdar; Reg Sauve; Jeffrey Johnson; William Ghali
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  26     ISSN:  1916-7075     ISO Abbreviation:  Can J Cardiol     Publication Date:    2010 Jun-Jul
Date Detail:
Created Date:  2010-06-15     Completed Date:  2010-07-15     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  178-84     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Calgary, Calgary, Canada. doreen.rabi@calgaryhealthregion.ca
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MeSH Terms
Descriptor/Qualifier:
Alberta / epidemiology
Atrial Fibrillation / drug therapy*,  etiology,  mortality
Cardioplegic Solutions
Coronary Artery Bypass / adverse effects*
Coronary Disease / surgery
Glucose / administration & dosage
Hospital Mortality / trends
Humans
Infusions, Intravenous
Insulin / administration & dosage
Potassium / administration & dosage
Survival Rate / trends
Treatment Outcome
Chemical
Reg. No./Substance:
0/Cardioplegic Solutions; 0/Insulin; 0/glucose-insulin-potassium cardioplegic solution; 50-99-7/Glucose; 7440-09-7/Potassium
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