Effect of perioperative glucose-insulin-potassium infusions on mortality and atrial fibrillation after coronary artery bypass grafting: A systematic review and meta-analysis |
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Authors: | Doreen M Rabi Fiona M Clement Finlay A McAlister Sumit R Majumdar Reg Sauve Jeffrey A Johnson William A Ghali |
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Institution: | 1Department of Medicine;;2Department of Community Health Sciences;;3Centre for Health and Policy Studies, University of Calgary, Calgary;;4Department of Medicine;;5Department of Public Health Sciences, University of Alberta, Edmonton;;6Department of Pediatrics, University of Calgary, Calgary, Alberta |
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Abstract: | 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 GIK/GI 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 and/or 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 GIK/GI does not significantly reduce mortality or atrial fibrillation in patients undergoing CABG surgery. Unless future trial data in support of GIK/GI 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. |
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Keywords: | Coronary artery bypass graft surgery GIK Insulin Meta-analysis |
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