As I noted last time, the authors reported 30-day outcomes. Now, they’re back, as promised, with 1-year outcomes – hoping to build on the “trends” previously observed.
Did it work? Did a longer follow-up period help? I’ll let the authors answer in their own words:
“The 1-year outcomes (Table 2) generally demonstrate point estimates favoring GIK for individual events and for composites, but CIs overlap 1.0 in most analyses.”Which is to say, no. Trends stayed trends, for the most part. And, considering the neutral pre-study evidence from such studies as CREATE-ECLA, which enrolled 20,201 patients, even such hopeful interpretations of these data should not inspire a change in practice.
It is still reasonable, however, as these authors suggest, to continue studying this treatment. There are small differences in important patient-oriented outcomes (10.9% vs. 13.0% in 1-year mortality) favoring the intervention. These effects were even more pronounced in the subgroup of patients for whom ST-elevation was present on the pre-hospital ECG. Considering there’s not much room left in acute medical management of STEMI offering a survival advantage – if there is, in fact, a 4.3% absolute 1-year survival attributable to GIK, it is worth continuing to investigate and tailor trials to the subgroup most likely to benefit.
“One-Year Outcomes of Out-of-Hospital Administration of Intravenous Glucose, Insulin, and Potassium (GIK) in Patients With Suspected Acute Coronary Syndromes”