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(Circulation. 1998;98:2223-2226.)
© 1998 American Heart Association, Inc.
Editorials |
Glucose-Insulin-Potassium for Acute Myocardial Infarction
Remarkable Results From a New Prospective, Randomized Trial
From the Cardiac Muscle Research Laboratory, Whitaker Cardiovascular Institute, Boston University School of Medicine and Cardiology Section, Boston Medical Center, Boston, Mass.
Correspondence to Dr Carl S. Apstein, Director, Cardiac Muscle Research Laboratory, Boston University School of Medicine, 700 Albany St, Boston, MA 02118. E-mail capstein@bu.edu
Key Words: Editorials • glucose • insulin • potassium • myocardial infarction
A landmark study is reported in this issue of Circulation,1 continuing the rediscovery of glucose-insulin-potassium (GIK) treatment of acute myocardial infarction (AMI) that began in this journal last year with a meta-analysis and editorial.2 3 That meta-analysis considered all prior randomized trials of GIK for AMI (these were all done in the prethrombolytic era) and concluded that GIK had the potential to reduce AMI mortality by 28% to 48% depending on dosage and timing of therapy initiation relative to symptom onset. An accompanying editorial called for a modern large-scale trial of GIK in combination with thrombolysis for AMI. Such a prospective trial is now reported by the ECLA (Estudios Cardiologicos Latinoamerica) Collaborative Group, and the results are dramatic.
The ECLA group reports the largest prospective, randomized trial of GIK for the treatment of AMI ever performed and the only such trial done in the era of thrombolytic therapy. They observed a remarkable 66% reduction (2P=0.008) in the relative in-hospital mortality risk when GIK was added to reperfusion (95% of those reperfused had thrombolysis, 5% had primary PTCA) relative to reperfusion alone; the absolute mortality risk decreased from 15.2% to 5.2%. Considering the relatively long average time from the onset of AMI symptoms until the start of treatment (10 to 11 hours), the magnitude of the mortality reduction was even more remarkable. Moreover, a survival benefit persisted during a 1-year follow-up period in the group that received high-dose GIK plus reperfusion as AMI treatment.
Adverse effects of the GIK
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