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May 28, 2008

Glucose-Insulin-Potassium Therapy in Patients With STEMI

JAMA. 2008;299(20):2385-2388. doi:10.1001/jama.299.20.jlt0528-a

To the Editor: We have concerns about possible conclusions of the study of glucose-insulin-potassium (GIK) therapy in patients with ST-segment elevation myocardial infarction (STEMI) by Dr Díaz and colleagues,1 which combined patients from the early-terminated OASIS-6 (Organization for the Assessment of Strategies for Ischemic Syndromes 6) trial with their previously published CREATE-ECLA Trial (Clinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction Treatment and Evaluation–Estudios Clinicos Latino America).2 In the earlier article, the investigators commented on a possible relationship between hyperglycemia and mortality. In a post hoc analysis in the study by Díaz et al,1 there was again an association of higher glucose with greater event rates, consistent with the association of diabetes mellitus with elevated glucose and with worse acute myocardial infarction (MI) outcomes.3 We do not believe that an inference of a causal link between mortality and GIK is justified by these data.