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June 1, 2005

Glucose-Insulin-Potassium Infusion and Mortality in the CREATE-ECLA Trial

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(21):2596-2598. doi:10.1001/jama.293.21.2596

To the Editor: I believe that the negative conclusions of the CREATE-ECLA trial regarding the effect of glucose-insulin-potassium (GIK) infusion on mortality in acute myocardial infarction (AMI)1 are not justified because of the late timing of the infusion. The metabolic actions of GIK can slow the rate of injury during severe ischemia but will not prevent it indefinitely; thus, GIK increases salvage from subsequent effective reperfusion.25 However, in CREATE-ECLA, reperfusion therapy was given a median of 3.8 to 3.9 hours after symptom onset, almost an hour before randomization to GIK or control groups occurred (a median of 4.7 hours after symptom onset). Moreover, GIK was not then started immediately but within the next hour (a median of 4.7-5.7 hours after symptom onset). Experimental studies have demonstrated marked anti-ischemic protection by GIK when it is started early and well before reperfusion3; in CREATE-ECLA, only 2.8% of patients were randomized within an hour of ischemia symptom onset.

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