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(Circulation. 1999;100:e106.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Optimal Dosage of Insulin and Glucose in Glucose-Insulin-Potassium Treatment of Acute Myocardial Infarction Remains to Be Established

Rolf Svedjeholm, MD, PhD; Erik Håkanson, MD, PhD; Zoltan Szabo, MD

Departments of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping Heart Center, University Hospital, Linköping, Sweden

	Introduction

 
To the Editor:

The dosage of insulin and glucose plays an important role for the efficacy of GIK (glucose-insulin-potassium) treatment. Until the ECLA study, only 4 trials in acute myocardial infarction (AMI) had used the GIK therapy required to achieve adequate suppression of plasma free fatty acids (FFAs).¹ Pooled data from these trials demonstrated a 48% reduction in mortality. In the ECLA study, a significant survival advantage relative to the control group was only found in the "high-dose GIK group."² In spite of these encouraging results, we do not yet know the optimal dosage of insulin and glucose in AMI.

To establish appropriate metabolic interventions, these should preferably be evaluated in the relevant clinical settings. Surprisingly little is known about the metabolic consequences of myocardial infarction in humans or the impact of metabolic interventions in this setting. In stable coronary artery disease, an infusion of 30 g of glucose, 50 IU of regular insulin, and 80 mmol of KCl per liter at 1.5 mL/kg body weight reduced myocardial FFA uptake and myocardial oxygen demand, whereas the uptake of glucose and lactate increased.³ In AMI, it was demonstrated that this regimen reduced the level of plasma FFAs substantially.⁴ However, its impact on myocardial metabolism in this setting remains obscure. The neuroendocrine stress response, for instance, may be expected to influence myocardial metabolism and attenuate the effect of GIK due to insulin resistance. In coronary surgery, where systematic studies on GIK and its effects on systemic and myocardial metabolism have been done . . . [Full Text of this Article]

Rafael Díaz, , MD

Director of ECLA Estudios Cardiológicos Latinoamérica, Director, Cardiovascular Department, Instituto Cardiovascular de Rosario, Rosario, Argentina

Darren K. McGuire, MD

Duke Clinical Research Institute Duke University Medical Center, Durham, NC