The benefits of glucose-insulin-potassium for acute myocardial infarction (and some concerns).

An important study by van der Horst et al. (1) from the Netherlands reported in this issue of the Journal presents the results of the largest prospectively randomized trial of glucose-insulin-potassium (GIK) treatment for acute myocardial infarction (AMI) ever done (940 patients) and the first to be done in concert with rapid, successful percutaneous transluminal coronary angioplasty (PTCA). The most important result was that GIK increased survival impressively in the 91% of patients who presented without heart failure (HF) (Killip class 1), reducing the 30-day mortality risk from 4.2% in the control group to 1.2% in the GIK group (p 0.01, relative risk reduction of 72%). In diabetics, there was a non-significant trend toward reduced mortality with GIK.