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

To the Editor: The CREATE-ECLA Trial Group reported the results of using high-dose GIK infusion in patients with acute STEMI, showing no benefit for mortality, cardiac arrest, or cardiogenic shock.¹ The DIGAMI trial reported positive outcomes of this treatment in patients with diabetes.² In DIGAMI, the investigators used a GIK infusion initially but also subsequently attempted good glycemic control with subcutaneous insulin during the initial hospital stay and after discharge. More pronounced improvement in outcomes was noted in patients who were at low risk or patients with diabetes who were previously not taking insulin. Another study of patients admitted with AMI, not previously diagnosed as having diabetes, showed that about two thirds had either abnormal glucose levels or newly diagnosed diabetes at discharge and 3 months later.³ It is reasonable to extrapolate from that study that a substantial number of patients included in the CREATE-ECLA trial, in which the mean baseline glucose level before randomization was 165 mg/dL, would have persistent glucose abnormalities. These were not addressed in the long term because treatment with GIK infusion lasted for a short duration, and no further follow-up information is provided regarding subsequent glucose levels or treatment strategies for those newly diagnosed as having diabetes or with abnormal glucose level.