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To the Editor: There is experimental evidence supporting 2 arguments for the ideal timing of administration of GIK for animal model MI, neither of which is covered by the data in the OASIS-6/CREATE-ECLA study by Dr Díaz and colleagues.¹ First, GIK infused to baboons within 1 hour of coronary ligation improved the myocardial markers of necrosis and levels of high-energy phosphates.² In longer dog experiments, GIK that was beneficial was started within 30 minutes of coronary ligation.³ Second, data on rodent hearts show that insulin given at the time of perfusion lessens reperfusion-induced myocardial injury,⁴ which in humans could be one-third of the threatened cells, as judged by diminished enzyme release after reperfusion with another intervention (ischemic postconditioning).⁴

The results in the group of patients undergoing reperfusion in the ECLA center are not reported separately, despite previous positive results.⁵ Hence it is not possible to know whether reperfusion injury was . . . [Full Text of this Article]

Lionel H. Opie, MD, DPhil
lionel.opie@uct.ac.za
Hatter Institute for Cardiovascular Research
Department of Medicine
University of Cape Town Faculty of Health Sciences
Cape Town, South Africa

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