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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-d

To the Editor: Metabolic modulation of the myocardium using a fixed-dose GIK infusion can result in acute hyperglycemia, which may have led to the early harmful effects of GIK therapy in the CREATE-ECLA and OASIS-6 trials by Dr Díaz and colleagues.1 Hyperglycemia reduces spontaneous reperfusion, decreases microvascular perfusion, and has detrimental effects on left ventricular remodeling after MI.2 An insulin infusion of 2.5 units per hour in acute MI while maintaining glycemic control (glucose level <140 mg/dL [to convert to mmol/L, multiply by 0.0555]) is associated with an anti-inflammatory, profibrinolytic, antioxidant, and cardioprotective effect.3 Insulin also has antiapoptotic effects; in a canine model of acute MI, low-dose insulin alone reduced myocardial infarct size while glucose and potassium led to hyperglycemia and increased infarct size.4