This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Statistics and Research Methods  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: We have a number of concerns about the clinical features of the CREATE-ECLA trial.¹ First, heparin used in coronary reperfusion therapy, such as the CREATE-ECLA patients received, blocks the key GIK physiological effect of lowering free fatty acids.² Unfortunately, CREATE-ECLA did not report free fatty acid levels or look for this effect.

Second, not only should GIK have been given earlier, but also the sequence of GIK and reperfusion in CREATE-ECLA should have been reversed. In the GIK group, 68% received reperfusion therapy before GIK, largely eliminating the proposed benefit of GIK use in ST-segment elevation MI (STEMI) of extending the time window for benefit from reperfusion.^3-4 No reperfusion therapy was received by 17% of GIK patients, for whom no such effect was possible. For only 14% of these patients, GIK was started before reperfusion, although only briefly so. The investigators noted higher mortality in these . . . [Full Text of this Article]

Leonard A. Cobb, MD
Harborview Medical Center
Seattle, Wash

Thomas Killip, MD
Beth Israel Medical Center
New York, NY

Costas T. Lambrew, MD
Maine Medical Center
Portland, Me

Bruce A. MacLeod, MD
Mercy Hospital
Pittsburgh, Pa

Charles E. Rackley, MD
Georgetown University Hospital
Washington, DC

Harry P. Selker, MD, MSPH
hselker@tufts-nemc.org
Tufts–New England Medical Center
Boston, Mass

Robert J. Zalenski, MD
Wayne State University Health Center
Detroit, Mich

RELATED ARTICLES

Glucose-Insulin-Potassium Infusion and Mortality in the CREATE-ECLA Trial
Carl S. Apstein
JAMA. 2005;293(21):2596-2597.
EXTRACT | FULL TEXT  

Glucose-Insulin-Potassium Infusion and Mortality in the CREATE-ECLA Trial
Jayant Dey, Lawrence Blonde, Alan Burshell, Peggy Bolton, and Anita Richard
JAMA. 2005;293(21):2597-2598.
EXTRACT | FULL TEXT  

Glucose-Insulin-Potassium Infusion and Mortality in the CREATE-ECLA Trial—Reply
Shamir R. Mehta, Salim Yusuf, Rafael Diaz, and Ernesto Paolasso
JAMA. 2005;293(21):2598.
EXTRACT | FULL TEXT  

Effect of Glucose-Insulin-Potassium Infusion on Mortality in Patients With Acute ST-Segment Elevation Myocardial Infarction: The CREATE-ECLA Randomized Controlled Trial
The CREATE-ECLA Trial Group Investigators*
JAMA. 2005;293(4):437-446.
ABSTRACT | FULL TEXT