 | Therapy With Glucose-Insulin-Potassium Infusion Not Beneficial for
Treating Heart Attack
JAMA. 2005;293:437-446.
In a related study in this week's JAMA, a widely applicable,
inexpensive therapy was found to have no effect on death rates when
treating patients who had an acute ST-segment elevation myocardial
infarction (STEMI), a heart attack with a specific finding on the
electrocardiogram.
Shamir R. Mehta, M.D., M.Sc., of McMaster University and Hamilton
Health Sciences, Hamilton, Ontario, Canada, and colleagues evaluated
the effects of high-dose glucose-insulin-potassium (GIK) infusion on
patients with acute STEMI. GIK is a low-cost therapy that has been
speculated to improve mortality in heart attack patients.
The study (a merger of CREATE and Estudios Cardiologicas Latin America
Study Group, ECLA [CREATE-ECLA]) was conducted in 470 centers
worldwide among 20,201 patients with STEMI who presented within 12
hours of symptom onset. The average age of patients was 58.6 years, and
evidence-based therapies were commonly used. Patients were randomly
assigned to receive GIK intravenous infusion for 24 hours plus usual
care (n = 10,091) or to receive usual care alone (controls; n =
10,110).
The researchers found: "The CREATE-ECLA trial demonstrated that
high-dose GIK solution given for 24 hours in patients presenting with
acute STEMI has a neutral effect on mortality, cardiac arrest, and
cardiogenic shock. The goal of our study was to reliably assess the
effects of high-dose GIK in preventing mortality and major
cardiovascular events in patients with STEMI. Given that there were
more than 1,900 deaths in the study, it was well powered to detect even
a moderate effect on mortality," the authors write. "The very high
adherence to the protocol and the excellent 30-day follow-up (99.85
percent) provide confidence in the validity of our findings and suggest
that it is very unlikely that the current regimen of high-dose GIK is
of any material benefit in reducing mortality in patients with
STEMI."
Editor's Note: This study had no external funding. Aventis Pharma
donated human insulin in India. Aventis Pharma had no role in the
design and conduct of the study, in the collection, analysis, and
interpretation of the data, or in the preparation, review, or approval
of the manuscript.
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