METABOLIC MODULATION OF ACUTE MYOCARDIAL-INFARCTION - THE ECLA GLUCOSE-INSULIN-POTASSIUM PILOT TRIAL

Background-Several trials have been performed in the past using glucos e, insulin, and potassium infusion (GIK) for the treatment of acute my ocardial infarction (AMI). Because of continuing uncertainty about the potential role of this therapeutic intervention, we conducted a rando mized trial to evaluate the impact of a GIK solution during the first hours of AMI, Methods and Results-Four hundred seven patients with sus pected AMI admitted within 24 hours of symptoms onset were enrolled. I n a ratio of 2:1, 268 patients were allocated to receive GIK (high- or low-dose) and 139 to receive control. Phlebitis and serum changes in the plasma concentration of glucose or potassium were observed more of ten with GIK, A trend toward a nonsignificant reduction in major and m inor in-hospital events was observed in patients allocated to GIK, In 252 patients (61.9%) treated with reperfusion strategies, a statistica lly significant reduction in mortality (relative risk [RR] 0.34; 95% C I: 0.15 to 0.78; 2P=0.008) and a consistent trend toward fewer in-hosp ital events in the GIK group were observed, Conclusions-Our results co nfirm that a metabolic modulation strategy in the first hours of an AM I is feasible, applicable worldwide, and has mild side effects. The st atistically significant mortality reduction in patients who underwent a reperfusion strategy might have important implications for the manag ement of AMI patients. It is now essential to perform a large-scale tr ial to reliably determine the magnitude of benefit.