Patients received intravenous solution a median of 90 minutes after onset of ischemic symptoms.
Cardiac ischemia can induce the release of free fatty acids, which in turn can increase the likelihood of arrhythmias. Glucose-insulin-potassium (GIK) reduces the level of free fatty acids. Prior trials of GIK in patients with acute coronary syndromes have produced uneven results, perhaps because the average time from ischemic symptoms to administration of GIK was 6 hours. In this randomized, placebo-controlled, double-blind trial, paramedics enrolled 871 patients (71% men) aged 30 or older (mean age, 63) with high probability of acute coronary syndrome based on electrocardiogram findings and clinical decision tools. Patients received intravenous GIK (30% glucose, 50 U/L regular insulin, and 80 mEq/L KCl at 1.5 mL/kg per hour for 12 hours) …