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Clinical Use of Glucose-Insulin-Potassium in Cardiac Surgery andAcute Myocardial Infarction: An Overview

Especially in patients with viable dysfunctional (hibernating) myocardium, adequate coronary revascularization may eventually lead to improved ventricular function, increased quality of life, and prolonged life expectancy. In light of the growing cohort of elderly patients with chronic heart failure (CHF), future demand for surgical revascularization will be significant. However, in spite of numerous cardioprotective strategies, morbidity and mortality following coronary artery bypass grafting (CABG) is still high in patients with CHF.1 Therefore, in those patients, the benefit of revascularization has to be balanced against the risk of morbidity and mortality. Table 1 shows the increased risks in octogenarians who are having cardiac surgery. Serious cardiovascular complications usually begin in the period following extracorporeal circulation (ECC). Acute ventricular failure, a condition probably caused by postischemic dysfunction or myocardial stunning, may develop at that time. This phenomenon may be superimposed on already preoperatively present impaired ventricular function. The etiologic mechanism involved in the occurrence of both hibernating and stunned myocardium is not yet fully understood; however, there is evidence that the intramyocardial availability of glucose, free fatty acids (FFA), and insulin is involved. Contractile function is sustained by the metabolism of both glucose and fatty acids. Lopaschuk2'3 described a competitive mechanism existing between both substrates used by the myocardium. Under normal conditions, fatty acids