IMMEDIATE

The IMMEDIATE-trial is out. A randomised, blinded and controlled study testing early infusion of intravenous glucose-insulin-potassium(GIK) on patients with acute coronary syndromes (ACS). The theory is that a GIK-infusion will reduce the frequency with which ACS progresses to myocardial infarction (MI) and also decreases overall mortality. All this, either by metabolic support of the ischemic myocardium or by preventing arrhythmias.

The concept is not new, it works in the laboratory, and has been tested in MI before. Unfortunately without evidence of any benefit. The problem with the prior studies was how the GIK was given only after hospital diagnosis of MI, which might be too late. In the IMMEDIATE-trial the GIK was given in the out-of-hospital-setting on the presentation of ACS, without waiting for in-hospital confirmation of a STEMI or MI.

The study
After exclusions they ended up with data from 68 GIK-patients and 72 who received placebo.  The primary endpoint was ACS progression to MI. Secondary end-points were mortality, cardiac arrest, development of heart failure. The data available was from the 30 first days.

Results
Prehospital GIK-administration did not significantly reduce ACS progression to MI, nor did it increase 30-day survival. But check out the results in the table below.

Generally the outcomes are in GIKs favour, but by now the study is too underpowered come to any conclusions from it. They do, however, generate a lot of interesting hypotheses for further studies. Abstract is here.

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