Heart attacks occur in about 735,000 Americans every year. “Of these, 525,000 are a first heart attack and 210,000 happen in people who have already had a heart attack,” according to the Centers for Disease Control and Prevention.
As a young nurse working in the ER in the 1980s, I remember our first patients who received tissue plasminogen activator (tPA). They had to have had symptoms of a heart attack within a certain time requirement in order to receive the new clot-busting drug.
It was a pretty exciting time to see how this innovative therapy allowed the return of blood flow to the patient’s coronary arteries.
Cardiologist Dr. Harry Selker worked hard in those early years to come up with better ways to manage those patients and predict who would benefit from these types of cardiac interventional therapies.
Clot-busting medications offer the most benefit if given within early hours of a heart attack or stroke.
Selker and his research group developed an EKG predictive tool to help doctors determine whether patients would do better using tPA or having an angioplasty to open up occluded blood vessels.
Selker went on to become dean and principal Investigator of Tufts Clinical and Translational Science Institute.
Now Selker is interested in another therapy, a mixture that might prevent heart attacks from happening in the first place. While this treatment has been around for years and was successfully tested in animals, it has not shown the same success in humans.
The solution is a mixture of glucose, insulin and potassium, known by its chemical initials GIK. It is given intravenously to prevent blood clots from forming in the coronary arteries that feed the heart.
Selker reviewed the data from the human trials and felt that the methods used contributed to their lack of success, including giving the GIK too late for it to work.
Selker and his colleagues designed a new study to test GIK in humans.
Paramedics were recruited in 13 cities to give their patients who appeared to be suffering a heart attack either the GIK solution or a plain 5 percent glucose solution (the placebo). This was a randomized, double blind study.
GIK solution was administered to 411 patients and the placebo was administered to 460 patients, based on their symptoms and EKG results between December, 2006 to July 31, 2011.
The GIK solution did not prevent more people from suffering heart attacks but those who received it were less likely to suffer cardiac arrest or death later while in the hospital.
“It also reduced the amount of heart damage by 80 percent,” according to NPR.
The study was published in the May, 2012, issue of the Journal of the American Medical Association.
Selker thought, based on these results, that there would be heightened interest to do more research and produce GIK solutions to be administered to those patients potentially suffering heart attacks.
The problem is that the GIK solution is not a money-maker for pharmaceutical companies. The ingredients are simple and have already been available for years.
So in order to get around this barrier, Selker reached out to the FDA to see if they would be willing to further test GIK for its benefit in acute coronary emergencies. He is very aware that to move forward with a new treatment, you have to try various avenues. It is not enough for the science to show that something is effective.
According to NPR, “Selker is hopeful that the next clinical trial for GIK will take place by early next year.”
Michele is an R.N. freelance writer with a special interest in women’s health care and quality of care issues.
Edited by Jody Smith
1) Heart Disease Facts. National Center for Chronic Disease Prevention and Health Promotion. Retrieved October 12, 2016.
2) This Doctor Is Trying To Stop Heart Attacks In Their Tracks. Retrieved October 12, 2016.
3) Clot-busting Medications for Heart Disease. Patient Education Center. Retrieved October 12, 2016.
4) Selker, Harry P. MD, MSPH et al. Out-of-Hospital Administration of Intravenous Glucose-Insulin-Potassium in Patients With Suspected Acute Coronary Syndromes. The IMMEDIATE Randomized Controlled Trial. JAMA. 2012;307(18):1925-1933.