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(Circulation. 1999;100:e104.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Glucose-Insulin-Potassium Use in Acute Myocardial Infarction

Ara Sadaniantz, MD

Division of Cardiology The Miriam Hospital, Providence, RI

	Introduction

 
To the Editor:

I read with interest the study of Diaz et al¹ regarding the ECLA Glucose-Insulin-Potassium Pilot trial. The provocative conclusions may potentially affect the care of patients with acute myocardial infarction (MI) and need to be substantiated by larger randomized trials, as the authors of both the study¹ and the accompanying editorial² have suggested. In addition, several aspects of the ECLA study need to be clarified in order to understand the results and design future studies.

I believe it is reasonable for a pilot study to select patients with suspected acute MI, regardless of ECG findings. However, it is prudent to report detailed initial ECG findings. Both Tables 1 and 2 include the percentage of patients with anterior MI, but this is not defined; it may be acute ST elevation, non–Q-wave MI, or subsequent Q-wave MI. Survival differences between MI with and without ST elevation have been reported by many well-designed large studies.³ Both Tables 1 and 2 include time from symptom onset to treatment. It is not stated whether this reported time is for initiation of GIK solution or reperfusion therapy. Time to treatment is a fundamental variable that influences outcome. This is particularly true for reperfusion therapy. Some of the observed differences among the groups may be due to time differences in treatment with reperfusion thrombolytic therapy.

Other data of importance include the criteria used by the authors for the diagnosis of MI, peak creatine kinase levels for each group, and ejection fraction. The effect of . . . [Full Text of this Article]