Evidence map›Paper›PMID 27502865›Full record

Trial reportAmerican heart journal2016

Very early administration of glucose-insulin-potassium by emergency medical service for acute coronary syndromes: Biological mechanisms for benefit in the IMMEDIATE Trial.

Harry P Selker, William S Harris, Charles E Rackley, Julian B Marsh, Robin Ruthazer, Joni R Beshansky, Eric J Rashba, Inga Peter, Lionel H Opie

Open access · greenAbstract readRandomized Controlled Trial
In one paragraph

Trial report in American heart journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.7field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 6 citations in OpenAlex.

  1. An Opportune Time to Consider Glucose-Insulin-Potassium Therapy for Takotsubo Syndrome.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2023
    Article
  2. EFFICACY-TO-EFFECTIVENESS CLINICAL TRIALS.Transactions of the American Clinical and Climatological Association · 2018
    Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 7 institutions in 2 countries.

Harry P SelkerInstitute for Clinical Research and Health Policy Study, Tufts Medical Center, Boston MA. Electronic address: hselker@tuftsmedicalcenter.org.
William S HarrisDepartment of Medicine, Sanford School of Medicine, University of South Dakota, SD.
Charles E RackleyDepartment of Medicine, Georgetown University Medical Center, Washington, DC.
Julian B MarshLipid Division, Department of Medicine, Tufts Medical Center, Boston, MA.
Robin RuthazerInstitute for Clinical Research and Health Policy Study, Tufts Medical Center, Boston MA.
Joni R BeshanskyInstitute for Clinical Research and Health Policy Study, Tufts Medical Center, Boston MA; Regis College, Regulatory and Clinical Research Management, Weston, MA.
Eric J RashbaDepartment of Internal Medicine, Stony Brook University School of Medicine, Stony Brook, NY.
Inga PeterIcahn School of Medicine at Mount Sinai, New York, NY.
Lionel H OpieHatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa.
Tufts Medical Center · USGeorgetown University · USIcahn School of Medicine at Mount Sinai · USRegis College · USStony Brook University · USUniversity of Cape Town · ZAUniversity of South Dakota · US

Funding

Tufts Clinical and Translational Research InstituteUL1TR001064 · NCATS · TUFTS UNIVERSITY BOSTON · PI SELKER, HARRY P. · 2013 to 2017
$26.4M
Early EMS and ED Use of GIK for ACS: The IMMEDIATE TrialU01HL077821 · NHLBI · TUFTS MEDICAL CENTER · PI SELKER, HARRY P · 2004 to 2006
$21.8M
Data Coordinating Center for IMMEDIATE TrialU01HL077826 · NHLBI · TUFTS MEDICAL CENTER · PI D'AGOSTINO, RALPH B · 2004 to 2006
$3.4M
LV Function Assessment Core Lab for IMMEDIATE TrialU01HL077823 · NHLBI · TUFTS MEDICAL CENTER · PI UDELSON, JAMES E · 2004 to 2006
$206k
NCATS NIH HHS UL1 TR001064NHLBI NIH HHS U01 HL077821NHLBI NIH HHS U01 HL077823NHLBI NIH HHS U01 HL077826
6 · The paper itself

Abstract

aimsIn the IMMEDIATE Trial, intravenous glucose-insulin-potassium (GIK) was started as early as possible for patients with suspected acute coronary syndrome by ambulance paramedics in communities. In the IMMEDIATE Biological Mechanism Cohort substudy, reported here, we investigated potential modes of GIK action on specific circulating metabolic components. Specific attention was given to suppression of circulating oxygen-wasting free fatty acids (FFAs) that had been posed as part of the early GIK action related to averting cardiac arrest.

methodsWe analyzed the changes in plasma levels of FFA, glucose, C-peptide, and the homeostasis model assessment (HOMA) index.

resultsWith GIK, there was rapid suppression of FFA levels with estimated levels for GIK and placebo groups after 2 hours of treatment of 480 and 781 μmol/L (P<.0001), even while patterns of FFA saturation remained unchanged. There were no significant changes in the HOMA index in the GIK or placebo groups (HOMA index: placebo 10.93, GIK 12.99; P = .07), suggesting that GIK infusions were not countered by insulin resistance. Also, neither placebo nor GIK altered endogenous insulin secretion as reflected by unchanging C-peptide levels.

conclusionThese mechanistic observations support the potential role of FFA suppression in very early cardioprotection by GIK. They also suggest that the IMMEDIATE Trial GIK formula is balanced with respect to its insulin and glucose composition, as it induced no endogenous insulin secretion.

Indexed as

Acute Coronary SyndromeAgedAngina PectorisBlood GlucoseC-PeptideEarly Medical InterventionElectrocardiographyEmergency Medical ServicesFatty Acids, NonesterifiedFemaleGlucoseHeart ArrestHumansHypoglycemic AgentsInfusions, IntravenousInsulinBlood GlucoseC-PeptideFatty Acids, NonesterifiedGlucoseHypoglycemic AgentsInsulinPotassium

Identifiers

PMID27502865
PMCPMC6390847
OpenAlexW2416344505

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.