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(Circulation. 1999;100:e105.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Glucose-Insulin-Potassium Use in Acute Myocardial Infarction

Tsung O. Cheng, MD

Professor of Medicine The George Washington University Medical Center, Washington, DC

	Introduction

 
To the Editor:

As my mentor Dr William Dock said, medical practice is like a pendulum: it swings back and forth every 20 to 30 years. Sodi-Pallares et al¹ in 1962 introduced the glucose-insulin-potassium infusion (GIK) for treatment of acute myocardial infarction. It was also called the "polarizing solution,"² but little did they know that this solution indeed polarized the cardiologists at that time to "believers" and "nonbelievers." Soon the GIK treatment for acute myocardial infarction fell into disrepute due to doubts and conflicting data about its efficacy; its use was subsequently abandoned.

Now Diaz et al³ on behalf of the ECLA (Estudios Cardiológicos Latinoamérica) Collaborative Group were able to show a dramatic reduction of death rate of acute myocardial infarction from 11.5% in the control group to 6.7% in patients treated with GIK. This is the largest reduction of mortality by any intervention that has been tried.⁴

The results of the GIK study by the ECLA group are most exciting and have serious clinical implications. The GIK treatment costs less than $50⁵ compared with over $10 000 for the current vogue of either thrombolytic treatment or catheter interventional therapy for acute myocardial infarction. In this era of managed health care, the economic impact will be tremendous.

	References

 
1. Sodi-Pallares D, Testelli MR, Fishleder BL, Bisteni A, Medrano GA, Friendland C, De Micheli A. Effects of an intravenous infusion of a potassium-glucose-insulin solution on the electrocardiographic signs of myocardial infarction: a preliminary clinical report. Am J Cardiol. 1962;9:166–181.[Medline] [Order article via Infotrieve]

2. Sodi-Pallares D, Bisteni A, Medrano GA, Testelli MR, De Micheli A. The polarizing treatment of acute myocardial infarction: possibility of its use in other cardiovascular conditions. Dis Chest. 1963;43:424–432.[Medline] [Order article via Infotrieve]

3. Diaz R, Paolasso EA, Piegas LS, Tajer CD, Moreno MG, Corvalán R, Isea JE, Romero G, on behalf of the ECLA (Estudios Cardiológicos Latinoamérica) Collaborative Group. Metabolic modulation of acute myocardial infarction: the ECLA Glucose-Insulin-Potassium Pilot Trial. Circulation. 1998;98:2227–2234.[Abstract/Free Full Text]

4. Apstein CS. Glucose-insulin-potassium for acute myocardial infarction: remarkable results from a new prospective, randomized trial. Circulation. 1998;98:2223–2226.[Free Full Text]

5. Josefson D. Old remedy proves useful for heart attacks. BMJ. 1998;317:1546.[Free Full Text]