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June 1, 2005

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

JAMA. 2005;293(21):2596-2598. doi:10.1001/jama.293.21.2598

In Reply: Dr Apstein refers to the Dutch GIPS 1 study as the “benchmark study” of GIK, yet this trial failed to demonstrate a significant benefit of GIK infusion in all randomized patients.1 Similarly, a presentation of the recently completed Dutch GIPS 2 study indicated no benefit of GIK on mortality or infarct size in patients with AMI treated early with primary PCI; in fact, the trial was stopped early by the safety monitoring committee because of a potentially higher mortality in the GIK group.2 These data are entirely consistent with the results of CREATE-ECLA,3 which was conducted largely in South America, India, and China, and suggest that interpretation of such trials should be based on their own relative merits, including internal and external validity, rather than on where the trial was conducted.

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