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Invited Commentary
November 11, 2013

Intensive Glucose Control in Hyperglycemic Patients With Acute Coronary Syndromes: Still Smoke, but No Fire…

Author Affiliations
  • 1Division of Endocrinology, Department of Medicine, School of Medicine and Biomedical Science, University at Buffalo, and the Diabetes and Endocrinology Center of Western New York, Buffalo
  • 2Department of Medicine, Samuel S. Stratton Albany Veterans Affairs Medical Center and Albany Medical Center, Albany Medical College, Albany, New York
JAMA Intern Med. 2013;173(20):1905-1906. doi:10.1001/jamainternmed.2013.8095

For more than 50 years, there has been considerable interest—and ongoing debate—as to the potential clinical benefits of interventions targeted to more intensively control elevated blood glucose levels in patients with acute myocardial infarction (MI) and, more recently, in those with acute coronary syndrome (ACS). In 1962, Sodi-Pallares et al introduced the glucose-insulin-potassium infusion (GIK) for treatment of acute MI.1,2 In 1972, Maroko and coworkers demonstrated a reduction in infarct size in dogs with experimental MI that were given an infusion of GIK.3 However, the use of GIK treatment for acute MI was largely abandoned over the ensuing years because of doubts and conflicting data about its efficacy, only to see interest return to this treatment when Diaz et al,4 on behalf of the Estudios Cardiológicos Latinoamérica (ECLA) Collaborative Group, showed a dramatic reduction in mortality after an acute MI from 11.5% in the control group to 6.7% in patients treated with GIK.

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