Related Experiment Video
Updated: May 12, 2026
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Glucose-insulin-potassium therapy in patients with ST-segment elevation myocardial infarction
Rafael Díaz1, Abhinav Goyal, Shamir R Mehta
1Etudios Cardiologica Latin America, Rosario, Argentina.
Insights
Glucose-insulin-potassium (GIK) infusion showed no benefit for ST-segment elevation myocardial infarction (STEMI) patients and may increase early harm. GIK therapy is not recommended due to potential risks of hyperglycemia, hyperkalemia, and fluid overload.
Area of Science:
- Cardiology
- Critical Care Medicine
- Metabolic Research
Background:
- The clinical utility of glucose-insulin-potassium (GIK) infusion in ST-segment elevation myocardial infarction (STEMI) remains uncertain, with conflicting results from previous studies.
- While some smaller trials suggested potential benefits, a large trial (CREATE-ECLA) found no effect on 30-day mortality in over 20,000 STEMI patients.
Purpose of the Study:
- To investigate the association between GIK infusion therapy and patient outcomes at 30 days and 6 months following STEMI.
- To analyze pooled data from multiple large-scale randomized controlled trials to provide a comprehensive assessment of GIK therapy in STEMI.
Main Methods:
- Primary analysis of the OASIS-6 GIK randomized controlled trial (2748 patients) and prespecified analyses combining data from OASIS-6 and CREATE-ECLA (22,943 patients).
- Subgroup analyses examined the impact of GIK initiation timing on outcomes.
- Post hoc analyses explored potential early harm associated with GIK, focusing on glucose levels, potassium levels, and net fluid gain.
Main Results:
- At 6 months in the OASIS-6 trial, GIK infusion showed no significant difference in mortality, heart failure, or the composite of death or heart failure compared to control.
- Combined analysis of OASIS-6 and CREATE-ECLA revealed a statistically significant increase in 3-day mortality with GIK infusion (HR, 1.13; P = .03), which disappeared by 30 days.
- GIK therapy increased glucose, potassium, and net fluid gain, all of which were independently associated with increased mortality; adjusting for these factors eliminated the early mortality benefit observed with GIK.
Conclusions:
- GIK infusion therapy offers no clinical benefit for patients with STEMI and may be associated with early harm.
- Future research on metabolic modulation in STEMI should consider avoiding or carefully managing infusion-related hyperglycemia, hyperkalemia, and net fluid gain.
Context:
The clinical benefit of glucose-insulin-potassium (GIK) infusion in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. While some smaller trials suggest benefit, in the CREATE-ECLA trial, GIK infusion had no effect on 30-day mortality in 20,201 patients.
Objectives:
To determine the association between GIK infusion therapy and 30-day and 6-month outcomes in patients with STEMI.
Design, Setting, And Participants:
Primary analysis of the OASIS-6 GIK randomized controlled trial of 2748 patients with acute STEMI; prespecified analyses of the combined trial data from the OASIS-6 GIK and CREATE-ECLA GIK trial populations of 22,943 patients with acute STEMI; subgroup analysis on the timing of initiation of GIK infusion therapy and outcomes; and post hoc analyses exploring whether GIK infusion may cause early harm by increasing glucose and potassium levels and net fluid gain.
Intervention:
High-dose GIK solution consisting of 25% glucose, 50 U/L of regular insulin, and 80 mEq/L of potassium infused at 1.5 mL/kg per hour for 24 hours.
Main Outcome Measures:
Mortality rates at 30 days and 6 months in the OASIS-6 GIK trial and rates of death, heart failure, and the composite of death or heart failure at 3 and 30 days in the combined OASIS-6 GIK and CREATE-ECLA GIK trial populations.
Results:
At 6 months, 148 (10.8%) GIK infusion patients and 143 (10.4%) control patients died in the OASIS-6 trial (hazard ratio [HR], 1.04; 95% CI, 0.83-1.31; P = .72); 153 (11.1%) GIK patients and 185 (13.5%) control patients had heart failure (HR, 0.83; 95% CI, 0.67-1.02; P = .08); and 240 (17.5%) GIK patients and 264 (19.2%) control patients had a composite of death or heart failure (HR, 0.91; 95% CI, 0.76-1.08; P = .27). In the prespecified analyses of the combined trial data, there were 712 deaths (6.2%) in the GIK group and 632 deaths (5.5%) in the control group at 3 days (HR, 1.13; 95% CI, 1.02-1.26; P = .03). This difference disappeared by 30 days, with 1108 deaths (9.7%) in the GIK group and 1068 (9.3%) in the control group (HR, 1.04; 95% CI, 0.96-1.13; P = .33). GIK therapy increased levels of glucose, potassium, and net fluid gain postinfusion, all 3 of which predicted death after adjusting for multiple confounders. Adjusting for glucose, potassium, and net fluid gain eliminated the apparent increase in mortality at 3 days observed with GIK infusion, suggesting a direct association with these factors. Administration of GIK infusion within 4 hours of symptom onset yielded no benefit compared with later initiation.
Conclusions:
Infusion of GIK provided no benefit and may cause early harm following STEMI. Avoidance of infusion-related hyperglycemia, hyperkalemia, and net fluid gain may be advisable in future studies of metabolic modulation in patients with STEMI.
Trial Registration:
clinicaltrials.gov Identifier: NCT00064428.
Related Concept Videos
01:26Heart Failure Drugs: Inotropic Agents
01:06Oral Hypoglycemic Agents: Glinides
01:23Dipeptidyl Peptidase 4 Inhibitors
01:14Myocarditis III: Medical Management
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care