Refractory hyperglycaemia induced by glucose-insulin-potassium infusion in acute myocardial infarction

Background. Recent randomised clinical trials have not confirmed the beneficial effects of glucose-insulin-potassium (GIK) infusion observed in experimental models of myocardial ischaemia and infarction. Methods. We investigated glucose levels and insulin dose in 107 patients treated with reperfusion therapy and GIK for acute myocardial infarction. Results. Despite high insulin infusion rates, persistent hyperglycaemia occurred in 37% of the patients. These patients had significantly larger infarctions, as measured by enzyme release (p=0.006). In a multivariate model predicting high troponin levels, refractory hyperglycaemia remained a significant parameter (p=0.02). Conclusion. These findings suggest that refractory hyperglycaemia caused by high-dose glucose infusion may, at least in part, explain the discrepancy between the experimental and clinical dat