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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-b

To the Editor: There is experimental evidence supporting 2 arguments for the ideal timing of administration of GIK for animal model MI, neither of which is covered by the data in the OASIS-6/CREATE-ECLA study by Dr Díaz and colleagues.1 First, GIK infused to baboons within 1 hour of coronary ligation improved the myocardial markers of necrosis and levels of high-energy phosphates.2 In longer dog experiments, GIK that was beneficial was started within 30 minutes of coronary ligation.3 Second, data on rodent hearts show that insulin given at the time of perfusion lessens reperfusion-induced myocardial injury,4 which in humans could be one-third of the threatened cells, as judged by diminished enzyme release after reperfusion with another intervention (ischemic postconditioning).4

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