葡萄糖-胰岛素-输注对急性ST段升高心肌梗塞患者的死亡率的影响:CREATE-ECLA随机对照试验
Shamir R Mehta1, Salim Yusuf, Rafael Díaz
1Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada. smehta@mcmaster.ca
JAMA
|January 27, 2005
概括
葡萄糖-胰岛素- (GIK) 输液并没有降低ST段升高心肌梗塞 (STEMI) 患者的死亡率. 这项大型试验在GIK和常规护理组之间没有发现死亡,心脏骤停或心脏性休克率的显著差异.
科学领域:
- 心脏病学 心脏病学
- 临床试验 临床试验
- 紧急医疗 紧急医疗
背景情况:
- 葡萄糖-胰岛素- (GIK) 输液是一种低成本的疗法,旨在降低急性ST段升高心肌梗塞 (STEMI) 的死亡率.
- 需要进行一项大规模的强化随机试验,以最终评估GIK对STEMI患者结果的影响.
研究的目的:
- 评估高剂量GIK输液对急性STEMI患者死亡率的影响.
主要方法:
- 一项全球随机对照试验,涉及20201名STEMI患者,在症状出现后12小时内出现.
- 患者接受了24小时静脉注射GIK输液加常规护理或单独接受常规护理.
- 评估30天后的主要结局包括死亡率,心脏骤停,心脏性休克和再发作.
主要成果:
- 没有观察到30天死亡率的显著差异:对照组9.7%,GIK组10.0% (HR,1.03;P = .45).
- 心脏骤停,心脏性休克和心脏复发的发生率在GIK和对照组之间也相似.
- 在预先指定的小组中没有发现任何益处,包括糖尿病患者或接受再注射治疗的患者.
结论:
- 高剂量的GIK输液在急性STEMI患者的死亡率,心脏骤停和心脏性休克上表现出中性作用.
- 这些发现不支持GIK输液的常规使用,以改善该患者群体的结果.
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