AMI treatment rejected in ’60s draws new attention

GIK cuts death rate in half

A simple, inexpensive treatment for acute myocardial infarction (AMI) that could be used successfully by low-technology hospitals worldwide can dramatically reduce the number of deaths, say researchers.

The treatment, giving the patient a mixture of sugar, insulin, and potassium to nourish heart muscles deprived of oxygen, was devised in 1962, but was discarded after poorly conducted clinical tests.

A new study indicates the earlier doubts were ill-founded.¹ Glucose can be used by heart tissue without oxygen, and insulin and potassium increase the muscle’s ability to take up the glucose. The combination also reduces the harmful high concentrations of free fatty acids present during the acute phase of an AMI.

In the study, GIK (glucose, insulin, and potassium) was administered to more than 400 heart attack patients who were either receiving a clot-busting drug or who had undergone angioplasty — and the overall death rate was reduced by half.

Carl S. Apstein, MD, of the Boston University School of Medicine called the trial "a landmark study" and said that it resulted in "the largest reduction of just about any intervention that has been tried."

Critics as well as researchers caution that the number of patients in the study is relatively small, and the study was not blinded. Instead of looking at the magnitude of the benefit, they say, one should look at its direction. They are organizing a larger trial, the GIK II International Study, expected to conclude in 2001, that will involve 10,000 heart attack patients at 400 centers throughout the world.

Reference

1. Diaz R, Paolasso EA, Piegas LS, et al. Metabolic modulation of acute myocardial infarction: The ECLA glucose-insulin-potassium pilot trial. Circulation 1998; 98:2,223-2,234.