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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-c

To the Editor: Dr Díaz and colleagues1 demonstrated in the primary analysis of the OASIS-6 trial and the prespecified analysis of the OASIS-6 and CREATE-ECLA trial populations that high-dose infusion of GIK provided no clinical benefit for reduction of 30-day and 6-month outcomes. Moreover, they found possible early harm secondary to hyperglycemia, hyperkalemia, and net fluid gain. However, previous trials investigating reperfusion status and outcomes with GIK by the ECLA study group2 and by Krljanac et al3 did show a benefit with GIK in patients undergoing reperfusion, and the effect was persistent at 1-year follow-up in both trials. The CREATE-ECLA trial4 also observed a lower 1-month mortality rate with GIK in the subgroup of patients treated with primary percutaneous coronary intervention (PCI), although the difference was not statistically significant. In addition, previous trials have reported long-term beneficial outcomes for patients with diabetes treated with GIK. For example, the DIGAMI trial5 showed significant 1-year reduction in mortality in patients with diabetes who received glucose-insulin compared with those treated conventionally.