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Glucose-Insulin-Potassium Infusion After Myocardial Infarction
The results of this large study showed no benefit for GIK infusion in STEMI patients.
Among patients who suffer MIs with ST-segment elevation (STEMI), metabolic modulation by infusion of high-dose glucose, insulin, and potassium (GIK) has shown promise in small trials. Such a therapy could provide a widely available, low-cost intervention in developing countries. In a trial of GIK, 20,201 patients with STEMI (74% of whom received thrombolytic therapy) were randomized (80% within 8 hours of symptom onset) to placebo or high-dose GIK infusion. Most of the trial subjects were in China, India, and Latin America; Chinese and Indian subjects also participated in a concurrent trial of reviparin (Journal Watch Feb 15 2005).
Mortality rates in the two groups were similar at 30 days (about 10%), as were rates of cardiac arrest (about 1.5%), cardiogenic shock (about 6%), and reinfarction (about 2%). No differences were found in several subgroup analyses (e.g., patients with diabetes, patients with heart failure).
Comment: This results of this clinical trial of high-dose GIK, which involved more patients than have all previous trials combined, demonstrated no benefit for GIK infusion in patients with STEMI. According to an editorialist, this study establishes, beyond a reasonable doubt, that GIK therapy is not worthwhile.
— Thomas L. Schwenk, MD
Published in Journal Watch General Medicine February 15, 2005
Citation(s):
The CREATE-ECLA Trial Group Investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: The CREATE-ECLA randomized controlled trial. JAMA 2005 Jan 26; 293:437-46.
- Original article (Subscription may be required)
- Medline abstract (Free)
Califf RM. Simple principles of clinical trials remain powerful. JAMA 2005 Jan 26; 293:489-91.
- Original article (Subscription may be required)
- Medline abstract (Free)
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