Abstract 2606: A Meta-Analysis of Glucose-Insulin-Potassium Therapy for Treatment of Acute Myocardial Infarction (1966:–2007:)

Abstract

Glucose-Insulin-Potassium (GIK) therapy has been proposed to provide metabolic support to the ischaemic myocardium through a shift from potentially harmfully free fatty acid metabolism to glucose metabolism. Our metanalysis published 10 years ago of 9 trials with 1932 patients demonstrated that GIK had an important role in reducing mortality post AMI. Since then, a number of larger randomised trials including CREATE ECLA, ECLA pilot, GIPS-I, GIPS-II, Pol-GIK and REVIVAL have been published investigating the role of GIK in the setting of AMI in modern thrombolysis / primary PCI era. Hence, we repeated our metanalysis to include these trials. A MEDLINE search for all randomized placebo-controlled studies of GIK therapy in AMI and meta-analysis of the mortality data was performed. We included 15 trials from 1966 to 2007 enrolling 25,635 patients. 30 day mortality in the GIK group was 1263 out of 12881 (9.8%) and in the placebo group 1259 out of 12748 (9.9%). Metanalysis of these 15 randomised trials did not reveal any benefit from GIK treatment, odds ratio 1.0, 95% CI 0.92 -1.08, P>0.05; see figure . Subgroup analysis of patients receiving high dose GIK or where reperfusion was not achieved still did not demonstrate any benefit of GIK. In conclusion, our current metanalysis performed on 15 randomised trials spanning over 40 years with 25,635 patients does not demonstrate any benefits of GIK on mortality post AMI. This may reflect differences in patient cohorts between modern era of AMI management and studies performed 20 –30 years ago used in our last metanalysis where control group mortality was 21%.