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Meta-Analysis
. 2010 Jun-Jul;26(6):178-84.
doi: 10.1016/s0828-282x(10)70394-9.

Effect of perioperative glucose-insulin-potassium infusions on mortality and atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis

Doreen Rabi  1 , Fiona Clement, Finlay McAlister, Sumit Majumdar, Reg Sauve, Jeffrey Johnson, William Ghali
Affiliations
Meta-Analysis

Effect of perioperative glucose-insulin-potassium infusions on mortality and atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis

Doreen Rabi et al. Can J Cardiol. 2010 Jun-Jul.

Abstract
in English, French

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 GIKGI 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 andor 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 GIKGI does not significantly reduce mortality or atrial fibrillation in patients undergoing CABG surgery. Unless future trial data in support of GIKGI 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.

HISTORIQUE :: Les infusions de glucose-insuline (associées [GIK] ou non [GI] à du potassium) sont préconisées en cas de pontage aortocoronarien (PAC) pour optimiser l’utilisation de glucose myocardique et réduire au minimum les lésions ischémiques.

OBJECTIF :: Effectuer une méta-analyse évaluant si le recours à des infusions périopératoires de GIK ou de GI réduit la mortalité ou la fibrillation auriculaire (FA) en milieu hospitalier après un PAC.

MÉTHODOLOGIE :: Les chercheurs ont fouillé des bases de données électroniques (Medline, EMBASE et Cochrane Central Register of Controlled Trials [CENTRAL]) et les références des articles obtenus pour trouver les essais aléatoires et contrôlés sur les effets de GIK ou de GI avant ou pendant un PAC sur la mortalité hospitalière ou la FA postopératoire. Ils ont calculé les RRR groupés et les 95 % d’IC pour chaque issue.

RÉSULTATS :: Les chercheurs ont repéré 20 essais admissibles à l’analyse. Le RRR résumé de mortalité hospitalière correspondait à 0,88 (95 % IC 0,56 à 1,40), d’après 44 décès chez 2 326 patients. Tandis que la FA postopératoire était une issue plus fréquente (observée chez 519 de 1 540 patients dans les dix essais faisant état de cette issue), l’évaluation groupée globale de l’effet n’était pas significative (RRR 0,79, 95 % IC 0,54 à 1,15). Cette dernière interprétation doit être interprétée avec prudence, car elle s’accompagne d’une importante hétérogénéité d’un essai à l’autre.

CONCLUSIONS :: Le recours périopératoire au GIK ou au GI ne réduit par la mortalité ou la FA de manière significative chez les patients qui subissent un PAC. À moins que de futures données tirées d’essais cliniques en appui aux infusions de GIK ou de GI ne soient publiées, il faudrait décourager l’utilisation systématique de ces traitements chez les patients subissant un PAC, car leur innocuité n’a pas fait l’objet d’un examen systématique.

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Figures

Figure 1)
Figure 1)
Identification of eligible studies. Afib Atrial fibrillation; CENTRAL Cochrane Central Register of Controlled Trials; GI Glucose-insulin infusion; GIK Glucose-insulin-potassium infusion
Figure 2)
Figure 2)
Forest plot for in-hospital mortality
Figure 3)
Figure 3)
Forest plot for postoperative atrial fibrillation
See this image and copyright information in PMC

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