Glucose-insulin-potassium (GIK) for acute myocardial infarction: a negative study with a positive value.

Glucose-insulin-therapy for acute myocardial infarction (AMI) has had a long history, going back 37 years to the pioneering concepts of Sodi-Pallares. Although a recent meta-analysis of a number of smaller trials has suggested mortality benefit, it is only the South American trial, published in Circulation in 1998, that has been large enough to show a mortality benefit of GIK infusions when compared with controls in the same trial. In contrast, the Polish study published in this issue of this journal produced a negative result. The two chief differences between the studies are the much higher risk of mortality of the patients chosen for the positive trial, and the much higher dose of GIK that was used. Despite this positive trial information, and the very extensive experimental background (which is here reviewed), the present data are not firm nor extensive enough to support the routine use of GIK in patients with AMI. Thus more trials based on the concepts of metabolic therapy are required and are being organized. At present, a careful strategy of patient selection is advocated. In the case of diabetics with AMI, current evidence is already strong enough to recommend routine use of modified GIK for all such patients.