Heart Attack Treatment Saves Lives

An inexpensive and low-tech heart attack treatment that has been around for decades has the potential to save thousands of lives each year, new research from the Netherlands suggests.

An inexpensive and low-tech heart attack treatment that has been around for decades has the potential to save thousands of lives each year, new research from the Netherlands suggests. In the largest study yet to examine the heart attack treatment, death rates fell by almost three-fourths among patients who had a heart attack but did not have subsequent heart failure. The treatment involves giving a glucose-insulin-potassium solution in the hours following a heart attack. “I consider this to be a landmark study for the treatment of [heart attacks],” writes Boston University School of Medicine cardiologist Carl S. Apstein, MD, who was not involved with the research but wrote an editorial accompanying it. It has the potential to save approximately 30,000 lives per year, he writes. It is not clear why the simple heart attack treatment saves lives, but researchers believe that glucose provides most of the heart-protecting benefit, with the insulin and potassium helping it get to the heart muscle. Glucose is the sugar that most cells in the body use for fuel. The study included 940 heart attack patients in the Netherlands. Half the patients were given the continuous glucose-insulin-potassium infusion for eight to 12 hours and the other half did not receive the heart attack treatment. If needed, the patients also received angioplasty — using a balloon to open the clogged artery that caused the heart attack. At first, the researchers did not see any evidence that the heart attack treatment improved survival chances. But when the 84 patients with signs of heart failure from the heart attack were removed from the analysis, a clear survival benefit emerged for the remaining 856 patients who received infusions.Thirty days after the heart attack treatment, the death rate was almost 75% lower among infusion patients — 1.2% vs. 4.2% for patients who did not receive infusions. The infusion patients also had fewer repeat heart attacks and repeat angioplasties. The findings are reported in the Sept. 3 issue of the Journal of the American College of Cardiology. Lead researcher Iwan C.C. van der Horst, MD, says it is not clear why patients with heart failure failed to benefit from the heart attack treatment, but he says the large volume of fluid involved in the infusion may be to blame. In a separate study involving 407 heart attack patients, a small survival advantage was seen among patients with heart failure who received the glucose-insulin-potassium infusions. In that study, only about half as much fluid was given. Too much fluid in someone with heart failure causes fluid to build up in the lungs. Van der Horst adds that the study’s findings need to be confirmed before the infusion becomes a routine heart attack treatment. Apstein says follow-up studies should be designed to determine if beginning the infusion earlier could further reduce heart attack deaths. American Heart Association spokesman Richard Becker, MD, tells WebMD that glucose-insulin-potassium infusion has been studied as a heart attack treatment since the 1960s but early trials were small and their results inconclusive. The University of Massachusetts Medical School cardiologist calls the latest findings “compelling” and says the heart attack treatment definitely merits further study. “These findings emphasize the importance of investigating metabolic therapies like this one,” he says. “A trial would probably need several thousand patients to provide the answers we need. But this is a widely available, inexpensive therapy, and if there is value to be had we certainly want to identify it.” (Source: Van der Horst, I. Journal of the American College of Cardiology, Sept. 3, 2003; vol 42: pp 784-791. Iwan C.C. van der Horst, MD, department of cardiology and internal medicine, Hospital de Weezenlanden, Zwolle, Netherlands. Carl S. Apstein, MD, FACC, Cardiac Muscle Research Laboratory, University School of Medicine, Boston. Richard Becker, MD, cardiologist, director of coronary care unit, Cardiovascular Thrombosis Research Center, University of Massachusetts Medical School: Salynn Boyles: WebMD Medical News)