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1. Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic

Author

Geevar Zachariah, Sivasubramanian Ramakrishnan, Mrinal Kanti Das, Abdullakutty Jabir, Pathiyil Balagopalan Jayagopal, Krishnannair Venugopal, Kalaivani Mani, Amal Kumar Khan, Amit Malviya, Anshul Gupta, Ashok Goyal, B.P. Singh, Bishav Mohan, Bishwa Bhushan Bharti, Biswajit Majumder, Bivin Wilson, Chakkalakkal Prabhakaran Karunadas, Chandra Bhan Meena, Cholenahally Nanjappa Manjunath, Mathew Cibu, Debabrata Roy, Dinesh Choudhary, Dipak Ranjan Das, Dipak Sarma, Meennahalli Palleda Girish, Gurpreet Singh Wander, Harsh Wardhan, Janakiraman Ezhilan, Karthik Tummala, Virender Kumar Katyal, Kewal Goswami, Kodangala Subramanyam, Krishna Kishore Goyal, Kenchappa Kumar, Lekha Adik Pathak, Manish Bansal, Manoranjan Mandal, Mohit Dayal Gupta, Narendra Nath Khanna, Natesh Bangalore Hanumanthappa, Neil Bardoloi, Nitin Modi, Nitish Naik, Pradeep K. Hasija, Prafulla Kerkar, Pranab Jyoti Bhattacharyya, Pushkraj Gadkari, Rabindra Nath Chakraborthy, Rahul Raosaheb Patil, Rakesh Gupta, Rakesh Yadav, Rambhatla Suryanarayana Murty, Ranjit Kumar Nath, Rathinavel Sivakumar, Rishi Sethi, Rituparna Baruah, Sanjay Tyagi, Santanu Guha, Santhosh Krishnappa, Satish Kumar, Satya Narayan Routray, Satyendra Tewari, Saumitra Ray, Seemala Saikrishna Reddy, Sharad Chandra, Shashi Bhushan Gupta, Shashi Shekhar Chatterjee, K.K.H. Siddiqui, Maduramuthu Sivabalan, Sreekanth Yerram, Sudeep Kumar, Swaminathan Nagarajan, Tom Devasia, Uday Jadhav, Varun Shankar Narain, Vijay Kumar Garg, Vitull K. Gupta, Dorairaj Prabhakaran, Pradip Kumar Deb, and Padinhare Purayil Mohanan

Subjects
Acute myocardial infarction (AMI), LMIC, Low-and middle-income country, COVID-19 pandemic, Acute coronary syndrome, ST elevation Myocardial infarction (STEMI), Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Aim: Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India. Methods & Results: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019.We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = −0·48; r2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. Conclusions: The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.

Published
2021
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2. Pattern of acute MI admissions in India during COVID-19 era: A Cardiological Society of India study - Rationale and design

Author

Sivasubramanian Ramakrishnan, Abdullakutty Jabir, Pathiyil Balagopalan Jayagopal, Padinhare Purayil Mohanan, Venugopal Krishnan Nair, Mrinal Kanti Das, Manoranjan Mandal, Debabrata Roy, Seemala Saikrishna Reddy, Amit Malviya, Bateshwar Prasad Singh, Bishwa Bhushan Bharti, Biswajit Majumder, Chakkalakkal Prabhakaran Karunadas, Chandra Bhan Meena, Meennahalli Palleda Girish, Janakiraman Ezhilan, Karthik Tummala, Virender Kumar Katyal, Kodangala Subramanyam, Krishna Kishore Goyal, Kumar Kenchappa, Mohit Dayal Gupta, Natesh Bangalore Hanumanthappa, Neil Bardoloi, Nitin Modi, Pranab Jyoti Bhattacharyya, Pushkraj Gadkari, Rahul Raosaheb Patil, Rambhatla Suryanarayana Murty, Rituparna Baruah, Santhosh Krishnappa, Satish Kumar, Satyanarayan Routray, Satyendra Tewari, Shashi Bhushan Gupta, Sivabalan Maduramuthu, Sreekanth Yerram, Sudeep Kumar, Uday Jadhav, Cholenahally Nanjappa Manjunath, Dorairaj Prabhakaran, Prafulla Kerker, Rakesh Yadav, Santanu Guha, Pradip Kumar Deb, and Geevar Zachariah

Subjects
Acute coronary syndrome, Acute myocardial infarction, Corona virus, COVID-19, Outcome, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. Methods: In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. Conclusions: This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

Published
2020
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3. Long QT syndrome with AV Wenckebaching & bundle branch block in a neonate

Author

Jay Relan, Jaskaran Singh Gujral, Seemala Saikrishna Reddy, Neeraj Parakh, Sukhjeet Singh, and Sivasubramanian Ramakrishnan

Subjects
Ashman phenomenon, Neonatal pacemaker, Neonatal syncope, Torsades de pointes, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

We present a case of 21-day-old neonate brought with history of 3 episodes of syncope. Evaluation revealed congenital long QT syndrome associated with long cycle atypical AV Wenkebaching with a long short cycle sequence related left bundle branch aberrancy. Syncope was attributed to multiple episodes of Torsades de Pointes, necessitating emergency epicardial pacemaker implantation. In addition, child was started on oral propranolol therapy. On 2 months follow up, child was stable with no ventricular high rate episodes during pacemaker interrogation.

Published
2020
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4. Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic

Author

Tom Devasia, Katyal Virender Kumar, Mrinal Kanti Das, Sreekanth Yerram, Narendranath Khanna, Nitish Naik, Geevar Zachariah, Swaminathan Nagarajan, Amal Kumar Khan, Neil Bardoloi, Pushkraj Gadkari, Gurpreet Singh Wander, Debabrata Roy, Kewal C. Goswami, Anshul Gupta, Bishav Mohan, Lekha Pathak, Cibu Mathew, Nitin Modi, Dipak Ranjan Das, Krishna Kishore Goyal, Bivin Wilson, Satyanarayan Routray, Venugopal Krishnan Nair, Shashi Bhushan Gupta, Chakkalakkal Prabhakaran Karunadas, Biswajit Majumder, Satyendra Tiwari, Sivabalan Maduramuthu, Rakesh Gupta, P.P. Mohanan, Kalaivani Mani, J. Ezhilan, Rahul Patil, K.R. Subramanyam, Santanu Guha, Saumitra Ray, Dinesh Choudhary, Rathinavel Sivakumar, Rituparna Baruah, Bishwa Bhushan Bharti, Santhosh Krishnappa, Manish Bansal, Rambhatla Suryanarayana Murty, Uday Jadhav, Prafulla Kerker, Siddiqui Kkh, Bateshwar Prasad Singh, Pradeep K. Hasija, Cholenahally Nanjappa Manjunath, Seemala Saikrishna Reddy, Karthik Tummala, Ashok Goyal, Natesh Bangalore Hanumanthappa, Sudeep Kumar, Ramakrishnan Sivasubramanian, Shashi Shekhar Chatterjee, Varun Shankar Narain, Diapk Sarma, Vitull K. Gupta, Sharad Chandra, Harsh Wardhan, Jayagopal Pathiyil Balagopalan, Rakesh Yadav, Girish Meennahalli Palleda, Vijay Kumar Garg, Pradip Kumar Deb, Sanjay Tyagi, C. B. Meena, Amit Malviya, Rishi Sethi, Ranjit Kumar Nath, Dorairaj Prabhakaran, Rabindra Nath Chakraborthy, A. Jabir, Pranab Jyoti Bhattacharyya, Manoranjan Mandal, Satish Kumar, Kumar Kenchappa, and Mohit Gupta

Subjects
Male, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, Logistic regression, Ventricular Function, Left, 0302 clinical medicine, Pandemic, 030212 general & internal medicine, Myocardial infarction, Non-ST Elevated Myocardial Infarction, Mortality rate, Middle Aged, Low-and middle-income country, Acute myocardial infarction (AMI), Patient volume, Non ST elevation Myocardial infarction (NSTEMI) and outcome, Female, Original Article, Acute coronary syndrome, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), RD1-811, India, COVID-19 pandemic, 03 medical and health sciences, LMIC, Percutaneous Coronary Intervention, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, Pandemics, Management practices, Aged, business.industry, COVID-19, Percutaneous coronary intervention, Stroke Volume, medicine.disease, Cross-Sectional Studies, RC666-701, Communicable Disease Control, Time course, Emergency medicine, ST Elevation Myocardial Infarction, Surgery, business, ST elevation Myocardial infarction (STEMI), Demography
Abstract

Background: Admissions for acute myocardial infarction (MI) have declined significantly during the COVID-19 pandemic. The changes in the presentation, management, and outcomes of MI during the pandemic period are not well recognized, and data from low- and middle-income countries are limited. Methods: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with MI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We sought to determine the changes in the number of admissions, management practices, and outcomes. Findings: We included 41,832 consecutive adults with MI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India with the North zone reporting greater decline (-44·8%) than the South zone (-27·7%). The weekly average decrease in MI admissions in 2020 which peaked around the mid- study period, correlated negatively with the number of COVID cases (r = -0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume, and teaching programs. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. However, the in-hospital mortality rates did not differ. Interpretation: The magnitude of reduction in MI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing MI admissions during the pandemic. Funding Statement: The study is funded by cardiological society of India. Declaration of Interests: Nothing to declare for all the authors. Ethics Approval Statement: Individual participating centres either obtained an ethical approval from respective Institutional ethics committees or a no objection certificate from the administration.

Published
2021

5. Long QT syndrome with AV Wenckebaching & bundle branch block in a neonate

Author

Sivasubramanian Ramakrishnan, Jaskaran Singh Gujral, Seemala Saikrishna Reddy, Sukhjeet Singh, Jay Relan, and Neeraj Parakh

Subjects
Long cycle, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, Long QT syndrome, Case Report, Torsades de pointes, Propranolol, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Physiology (medical), Internal medicine, Left bundle branch, medicine, 030212 general & internal medicine, Neonatal syncope, Bundle branch block, biology, Neonatal pacemaker, business.industry, Syncope (genus), medicine.disease, biology.organism_classification, Ashman phenomenon, lcsh:RC666-701, Cardiology, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

We present a case of 21-day-old neonate brought with history of 3 episodes of syncope. Evaluation revealed congenital long QT syndrome associated with long cycle atypical AV Wenkebaching with a long short cycle sequence related left bundle branch aberrancy. Syncope was attributed to multiple episodes of Torsades de Pointes, necessitating emergency epicardial pacemaker implantation. In addition, child was started on oral propranolol therapy. On 2 months follow up, child was stable with no ventricular high rate episodes during pacemaker interrogation.

Published
2020

6. Pattern of acute MI admissions in India during COVID-19 era: A Cardiological Society of India study - Rationale and design

Author

J. Ezhilan, Venugopal Krishnan Nair, Chakkalakkal Prabhakaran Karunadas, Uday Jadhav, Dorairaj Prabhakaran, Sivabalan Maduramuthu, A. Jabir, Biswajit Majumder, Satish Kumar, Debabrata Roy, Sivasubramanian Ramakrishnan, Pranab Jyoti Bhattacharyya, Mohit Gupta, Karthik Tummala, Krishna Kishore Goyal, M.P. Girish, Satyanarayan Routray, Bishwa Bhushan Bharti, Pushkraj Gadkari, Kumar Kenchappa, Nitin Modi, Bateshwar Prasad Singh, Manoranjan Mandal, K.R. Subramanyam, C. B. Meena, Rituparna Baruah, P.P. Mohanan, Cholenahally Nanjappa Manjunath, Natesh Bangalore Hanumanthappa, Santanu Guha, P.B. Jayagopal, Rambhatla Suryanarayana Murty, Satyendra Tewari, Seemala Saikrishna Reddy, Amit Malviya, Santhosh Krishnappa, Geevar Zachariah, V.K. Katyal, Pradip Kumar Deb, Rakesh Yadav, Sreekanth Yerram, Mrinal Kanti Das, Sudeep Kumar, Neil Bardoloi, Prafulla Kerker, Rahul Patil, and Shashi Bhushan Gupta

Subjects
Male, GCP, good clinical practice, Cross-sectional study, Myocardial Infarction, Comorbidity, 030204 cardiovascular system & hematology, 0302 clinical medicine, Patient Admission, Pandemic, 030212 general & internal medicine, Societies, Medical, Outcome, Incidence (epidemiology), Mortality rate, Incidence, Female, Original Article, Acute coronary syndrome, Cardiology and Cardiovascular Medicine, Emergency Service, Hospital, Adult, medicine.medical_specialty, Corona virus, RD1-811, Cardiology, India, Acute myocardial infarction, ACS, Acute coronary syndrome, 03 medical and health sciences, STEMI, ST elevation myocardial infarction, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, cardiovascular diseases, Pandemics, Retrospective Studies, business.industry, SARS-CoV-2, COVID-19, Retrospective cohort study, ICMR, Indian council of medical research, medicine.disease, CSI, cardiology society of India, AMI, acute myocardial infarction, Cross-Sectional Studies, RC666-701, COVID 19, corona virus disease of 2019, Emergency medicine, Door-to-balloon, Observational study, Surgery, NSTEMI, non-STEMI, business
Abstract

Background COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. Methods In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. Conclusions This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

Published
2020

7. Effect of Glucose-Insulin-Potassium Infusion on Mortality in Patients With Acute ST-Segment Elevation Myocardial Infarction

Author

H. Ge, A. Gentile, H. Yang, X. Guo, H. Bai, R. B. Panwar, R. Crivello, V. E. Shegokar, Supriya Patil, X. Sun, M. Y. Bai, Sonia Gupta, S. Shanmugasundaram, D. X. Li, S. Dwivedi, J. P. Albisu, N. Dinesh, R. Liu, Rajvir Singh, S. M. Macin, J. Tang, H. Tan, K. Wang, S. Jia, L. L. Lobo Marquez, C. Baigent, K. Varghese, S. T. Zhang, Prafulla Kerkar, A. V. Bindu, R. Umrani, P. Yang, S. Sanghvi, F. Wang, Z. X. Liu, S. Tredici, Y. Cao, I. Tsuluca, Ratnakar, W. G. Li, N. Chidambaram, P. J. Nathani, Ravi Mehrotra, D. Qiao, A. S. Jain, S. S. Fatima, P. Baselga, D. Wojdyla, Sudhir Naik, J. B. Bijapure, J. Fu, Q. Zhang, Z. Ma, X. Xu, J. Srinivas, Jun Zhu, O. Pellizon, J. Martinez Sanchez, P. Castro, R. E. Ledesma, U. Legler, Q. Cui, Janice Pogue, M. Chenniappan, N. F. Zho, Atanu Biswas, C. M. Yang, M. Garrido, D. Duggal, Shamir R. Mehta, E. Hernandez Leyva, C. E. Girino, N. Wang, Z. Fang, R. Udaysankar, S. C. Manchanda, G. Wang, X. Zhao, R. Monti, H. R. Devendrappa, Harvey D. White, J. Rajesh, J. Wei, N. Wu, R. K. Tongia, L. R. Cartasegna, E. M. Good God, S. Fan, C. Zai, E. Carrillo, S. N. Ferreyra Cantante, R. J. Ahmed, J. Prajapati, X. Hao, M. Fulwani, S. K. Rane, B. S.V. Raj, D. Freeda, J. Bono, A. J. Gambarte, G. Reis, S. Dong, Amal Kumar Khan, Z. R. Tian, M. S. Rao, Denis Xavier, Rinku Sharma, Y. Q. Jiang, B. K.S. Sastry, Y. Wang, V. S. Reddy, X. Yin, G. S.R. Murthy, W. Li, M. G. Yang, DC Rao, M. J. Santhosh, F. Huo, A. K. Maity, T. Wang, J. A. Sanchez, Prem Pais, J L Ramos, S. R. Mehta, S. Y. Lang, P. Gandhimadhinathan, K. K. Haridas, Sanjoy K. Paul, J. Shao, L. H. Wang, S. Mehrotra, S. Wang, B. Isaac, Pradeep Kumar, Luiz Carlos Bodanese, S. Zhang, X. Zhang, Job E. Lopez, C. Becerra, S. S. Iyengar, V. K. Puri, L. S. Zhou, F. Guan, R. Kishore, A. Nambiar, Kadir González, S. Y. Fu, S. Pavlov, R. Pitarch Flors, B. M. Lombana, X. Jiang, G. F. Xie, B. S. Raju, E. Assanelli, P. Nyayadhish, Abdul Hameed, Shriprakash Kalantri, U. Magin, V. S.P. Rao, D. F. Li, C. Y. Liu, E. B. Manoj, Z. Wang, L. Liu, D. M. Mello Soares, K. Soomro, H. Zhang, G. J. Yang, A. Puri, R. Zhqo, A. A. Fernandez, S. Raghavan, J. C. Zhou, W. Zhang, I. Chandna, T. Yang, S. C. Xu, J. Li, M. Zhao, J. Zhang, L. Hao, R. F. Ramos, R. Rajaram, S. Shang, Y. Yang, G. Verma, G. Tao, Y. Miao, P. Castro Galvez, H. Ma, R. Ma, N. L. Sun, E. M. Avila, A. Kalla, S. Ren, C. R. Castellanos, J. Boben, X. You, R. Beniwal, Z. Nan, R. J. Barcudi, Changchun Xie, S. Lidwin, P. R. Nayak, S. S. Ramesh, Cláudia B.R. Martinez, Z. D. Wu, A. Caccavo, Javed Tai, Y. Han, Y. S. Wu, D. Hu, Sharad Chandra, P. B. Latha, Y. Tu, S. Chen, A. Garg, D. Q. An, K. J. Nesaraj, M. Alcaino, X. C. Xu, S. P. Ma, L. Cronin, J. J. Cui, L. Marsano, P. Sleight, H. Saad, H. Liu, Alvaro Avezum, F. Torres, O. P. Soni, G. K. Aneja, Rafael Diaz, R. Guo, H. ul Banna, B. Srinivasulu, Q. F. Zhang, S. Yusuf, J. Zhu, H. S. Yang, W. Wang, P. Ramesh, D. Agnelli, J. Liu, X. Y. Shi, Salim Yusuf, S. K. Trivedi, S. G. Yang, Darren K. McGuire, W. K. Li, H. L. Luciardi, Q. Li, G. Huang, F. Van de Werf, J. Huang, S. B. Siwach, I. Rasool, Q. Zheng, X. Chi, Álvaro Pascual, E. Marzetti, Antonio Carlos Carvalho, Y. Zhang, M. A. Alvarez, S. D. Zawar, Johny Joseph, Y. C. Song, C. B. Xu, C. He, Bateshwar Prasad Singh, R. J. Freedman, Ramón Corbalán, C. Cheng, R. Trehan, S. L. Tungikar, P. Pais, P. K. Shetty, Z. R. Lu, Pradeep Joshi, M. Molec, L. Prestes, C. A. Cuneo, Ernesto Paolasso, Y. Q. Li, S. Rehman, J. Ma, Wael Almahmeed, M. A. Berli, L. Soares Piegas, D. Almeida, Z. M. Xu, G. Sidhu, R. A. Ahuad Guerrero, Z. Fan, U. K. Mahorkar, X. Tan, J. E. Isea Perez, T. Pradeep, S. M. Li, S. Zhou, P. J.C. Lujan, M. A. Hominal, A. D. Orlandini, R. Wang, S. A. Khan, N. Transk, Dorairaj Prabhakaran, Z. Hou, J. Pogue, Y. H. Liu, R. A. Peleteiro Mariño, K. N. Pradeep, John N. Nanas, A. Hamer, V. Mezzina, M. I. Genisans, P. Srinivas, E. Manenti, H. Singh, S. Adil, E. Ferro Queirel, N. Bender, D. Li, J. Cheng, Susmita Kaushik, J. Lou, R. K. Jain, J. Hiremath, V.K. Katyal, F. Zhao, Y. Jiang, Y. G. Zhang, N. Dadani, S. Thanikachalam, Khawar Kazmi, G. Yang, X. Tian, D. Barkavi, Ashok Kumar, X. Ma, W. J. Zhang, C. Shen, Q. L. Li, F. Li, W. Chen, A. Alves De Lima, B. Wang, D. Tian, T. N.C. Padmanabhan, M. B. Rao, A. Kalanidhi, K. Bhojomal, Lisheng Liu, G. D. Caime, N. G. Mohanarjun, B. R. Babu, F. Zhangfang, P. Bacher, L. Marano, S. Y. Liu, H. Xu, K. Ahmed, J. Narendra, Y. Xia, T. M. Jaison, G. Tognoni, X. Li, B. Yang, R. Calton, S. Sinha, A. R. Gonzalez Medina, S. Y. Yu, E. Paolasso, G. Qi, J. Muntaner, C. Z. Zhang, K. Jing, M. Ramesh, N. Cano Lopez, Rajnish Joshi, S. L. Liu, S. Balasubramaniyan, R. J. Balado, G. Deepak, Q. P. Wang, J. G. De Castro Amino, J. K. Chhaparwal, Q. Wang, X. Yang, L. Gong, Z. Zhang, Y. Kumble, A. Bharani, A. S.V.N. Rao, R. Corbalán Herreros, B. J. Kumar, G. Jacob, Y. Sun, S. Fu, Z. Xu, Z. C. Li, S. W. Wang, U. Raschke, D. Xavier, M. A. Brito, W. Liu, L. Li, G. Amuchastegui, S. Verma, W. Taylor, M. Rafiq, Jagdish, Mohammad Zubaid, J. Zhou, Sanjay Kalra, L. Yan, J. Carrillo Calvillo, I. Holadyk-Gris, S. R. Naik, Andrés Orlandini, T. X. Cui, H. Ozcoidi, Shweta Sharma, T. Chen, G. Covelli, Seemala Saikrishna Reddy, Y. Qin, D. H. Yan, G. Zapata, J. Lopez Ferre, A. Bozzano, R. Wadhwani, S. T. Chandy, J. Zhao, Rakesh Gupta, M. Gao, G. Xu, B. R. Malipeddi, A. Somani, A. Abdulminem, G. M. Font, K. Jeremaiah, K. G. Alexander, Jinhai Yang, C. Mata, H. R. Ramos, V. Vijan, Z. Zhen, Prashant P. Joshi, H. U. Banna, Z. C. Liu, O. A. Perrino, X. J. Bai, F. S. Zhou, J. O. Balbi, P. Papazoglou, H. Li, S. Dani, Z. Li, A. Nejrotti, H. G. Yang, R. Uchoa Azevedo, J. F. Shallam, Jack Hirsh, John Kanakakis, Rashid J. Ahmed, A. M. Faruqi, K. D. Rao, P. A. Jiwani, S. Borade, M. San Mauro, H. Chen, R. G. Salkar, X. Wang, P.P. Mohanan, A. Li, Anubhav Mittal, K. Zai, P. Guo, Carmen de la Cuesta, R. Nordaby, and Q. Meng

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Cardiogenic shock, Percutaneous coronary intervention, Context (language use), General Medicine, Thrombolysis, medicine.disease, law.invention, Reperfusion therapy, Randomized controlled trial, law, Heart failure, Internal medicine, medicine, Cardiology, Myocardial infarction, Medical emergency, business
Abstract

Context Glucose-insulin-potassium (GIK) infusion is a widely applicable, low-cost therapy that has been postulated to improve mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Given the potential global importance of GIK infusion, a large, adequately powered randomized trial is required to determine the effect of GIK on mortality in patients with STEMI. Objective To determine the effect of high-dose GIK infusion on mortality in patients with STEMI. Design, setting, and participants Randomized controlled trial conducted in 470 centers worldwide among 20,201 patients with STEMI who presented within 12 hours of symptom onset. The mean age of patients was 58.6 years, and evidence-based therapies were commonly used. Intervention Patients were randomly assigned to receive GIK intravenous infusion for 24 hours plus usual care (n = 10,091) or to receive usual care alone (controls; n = 10,110). Main outcome measures Mortality, cardiac arrest, cardiogenic shock, and reinfarction at 30 days after randomization. Results At 30 days, 976 control patients (9.7%) and 1004 GIK infusion patients (10.0%) died (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.95-1.13; P = .45). There were no significant differences in the rates of cardiac arrest (1.5% [151/10 107] in control and 1.4% [139/10,088] in GIK infusion; HR, 0.93; 95% CI, 0.74-1.17; P = .51), cardiogenic shock (6.3% [640/10 107] vs 6.6% [667/10 088]; HR, 1.05; 95% CI, 0.94-1.17; P = .38), or reinfarction (2.4% [246/10,107] vs 2.3% [236/10,088]; HR, 0.98; 95% CI, 0.82-1.17; P = .81). The rates of heart failure at 7 days after randomization were also similar between the groups (16.9% [1711/10,107] vs 17.1% [1721/10,088]; HR, 1.01; 95% CI, 0.95-1.08; P = .72). The lack of benefit of GIK infusion on mortality was consistent in prespecified subgroups, including in those with and without diabetes, in those presenting with and without heart failure, in those presenting early and later after symptom onset, and in those receiving and not receiving reperfusion therapy (thrombolysis or primary percutaneous coronary intervention). Conclusion In this large, international randomized trial, high-dose GIK infusion had a neutral effect on mortality, cardiac arrest, and cardiogenic shock in patients with acute STEMI.

Published
2005

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