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Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: The CREATE-ECLA randomized controlled trial

Publication ,  Journal Article
Mehta, SR; Yusuf, S; Díaz, R; Zhu, J; Pais, P; Xavier, D; Paolasso, E; Ahmed, R; Xie, C; Kazmi, K; Tai, J; Orlandini, A; Pogue, J; Liu, L ...
Published in: Journal of the American Medical Association
2005

Context: Glucose-insulin-potassium (GIK) infusion is a widely applicable, low-cost therapy that has been postulated to improve mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Given the potential global importance of GIK infusion, a large, adequately powered randomized trial is required to determine the effect of GIK on mortality in patients with STEMI. Objective: To determine the effect of high-dose GIK infusion on mortality in patients with STEMI. Design, Setting, and Participants: Randomized controlled trial conducted in 470 centers worldwide among 20201 patients with STEMI who presented within 12 hours of symptom onset. The mean age of patients was 58.6 years, and evidence-based therapies were commonly used. Intervention: Patients were randomly assigned to receive GIK intravenous infusion for 24 hours plus usual care (n = 10091) or to receive usual care alone (controls; n = 10110). Main Outcome Measures: Mortality, cardiac arrest, cardiogenic shock, and reinfarction at 30 days after randomization. Results: At 30 days, 976 control patients (9.7%) and 1004 GIK infusion patients (10.0%) died (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.95-1.13; P=.45). There were no significant differences in the rates of cardiac arrest (1.5% [151/10107] in control and 1.4% [139/10088] in GIK infusion; HR, 0.93; 95% CI, 0.74-1.17; P=.51), cardiogenic shock (6.3% [640/10107] vs 6.6% [667/10088]; HR, 1.05; 95% CI, 0.94-1.17; P=.38), or reinfarction (2.4% [246/10107] vs 2.3% [236/10088]; HR, 0.98; 95% CI, 0.82-1.17; P=.81). The rates of heart failure at 7 days after randomization were also similar between the groups (16.9% [1711/10107] vs 17.1% [1721/ 10088]; HR, 1.01; 95% CI, 0,95-1.08; P=.72). The lack of benefit of GIK infusion on mortality was consistent in prespecified subgroups, including in those with and without diabetes, in those presenting with and without heart failure, in those presenting early and later after symptom onset, and in those receiving and not receiving reperfusion therapy (thrombolysis or primary percutaneous coronary intervention). Conclusion: In this large, international randomized trial, high-dose GIK infusion had a neutral effect on mortality, cardiac arrest, and cardiogenic shock in patients with acute STEMI.

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Published In

Journal of the American Medical Association

DOI

ISSN

0098-7484

Publication Date

2005

Volume

293

Issue

4

Start / End Page

437 / 446

Related Subject Headings

  • General & Internal Medicine
  • 11 Medical and Health Sciences
 

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Mehta, S. R., Yusuf, S., Díaz, R., Zhu, J., Pais, P., Xavier, D., … Carrillo, E. (2005). Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: The CREATE-ECLA randomized controlled trial. Journal of the American Medical Association, 293(4), 437–446. https://doi.org/10.1001/jama.293.4.437
Mehta, S. R., S. Yusuf, R. Díaz, J. Zhu, P. Pais, D. Xavier, E. Paolasso, et al. “Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: The CREATE-ECLA randomized controlled trial.” Journal of the American Medical Association 293, no. 4 (2005): 437–46. https://doi.org/10.1001/jama.293.4.437.
Mehta SR, Yusuf S, Díaz R, Zhu J, Pais P, Xavier D, et al. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: The CREATE-ECLA randomized controlled trial. Journal of the American Medical Association. 2005;293(4):437–46.
Mehta, S. R., et al. “Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: The CREATE-ECLA randomized controlled trial.” Journal of the American Medical Association, vol. 293, no. 4, 2005, pp. 437–46. Scival, doi:10.1001/jama.293.4.437.
Mehta SR, Yusuf S, Díaz R, Zhu J, Pais P, Xavier D, Paolasso E, Ahmed R, Xie C, Kazmi K, Tai J, Orlandini A, Pogue J, Liu L, Cronin L, Gupta R, Haridas KK, Jaison TM, Joshi PP, Kerkar PG, Maity AK, Manchanda SC, Naik S, Prabhakaran D, Reddy S, Singh B, Thanikachalam S, Bai XJ, Chen T, Cui JJ, Cui TX, Fu SY, Ge H, Li QL, Li SM, Li W, Li YQ, Liu YH, Lu ZR, Ma SP, Qiao D, Song YC, Sun NL, Wang LH, Wang SW, Wang W, Wang Y, Wu N, Wu YS, Xu CB, Xu SC, Xu ZM, Yang GJ, Yang HS, Zhang CZ, Zhang ST, Zhang WJ, Zhou JC, Almahmeed W, Avezum A, Castro P, Corbalán R, Flors RP, Lombana BM, Marano L, Mcguire D, Perez JEI, Piegas LS, Werf FVD, White H, Zubaid M, Faruqi AM, Rasool I, Soomro K, Banna HU, Ahmed RJ, Pavlov S, Zhao F, Tsuluca I, Molec M, Holadyk-Gris I, Ahmed K, Freeda D, Lidwin S, Chenniappan M, Isaac B, Iyengar SS, Joshi P, Kalantri SP, Kaushik SK, Mahorkar UK, Narendra J, Paul SK, Santhosh MJ, Sastry BKS, Siwach SB, Varghese K, Yang H, Yang Y, Zhang X, Tan H, Tang J, Li X, Yan L, Zhang Y, Li J, Bai MY, Jiang YQ, Lang SY, Shi XY, Tian ZR, Wang K, Yan DH, Yu SY, Pascual A, Ozcoidi H, Cuesta C, Wojdyla D, Font GM, Genisans MI, Chandna I, Rafiq M, Dadani N, Fatima SS, Rehman S, Adil S, Bhojomal K, Hameed A, Khan SA, Sleight P, Baigent C, Hirsh J, Taylor W, Tognoni G, Bacher P, Bender N, Legler U, Magin U, Raschke U, Mauro MS, Brito MA, Lima AAD, Guerrero RAA, Nordaby R, Barcudi RJ, Bono J, Ledesma RE, Ramos HR, Caccavo A, Macin SM, Cantante SNF, Caime GD, Cartasegna LR, Perrino OA, Gambarte AJ, Marzetti E, Garrido M, Balado RJ, Martinez CB, Fernandez AA, Queirel EF, Balbi JO, Amuchastegui G, Covelli G, Gentile A, Girino CE, López J, Monti R, Orlandini AD, Pellizon O, Ramos JL, Zapata G, Cuneo CA, Sanchez JA, Albisu JP, Berli MA, Hominal MA, Mariño RAP, Mezzina V, Avila EM, Baselga P, Castellanos CR, Luciardi HL, Marquez LLL, Muntaner J, God EMG, Reis G, Soares DMM, Bodanese LC, Manenti E, Prestes L, Amino JGDC, Azevedo RU, Carvalho ACC, Ramos RF, Alcaino M, Galvez PC, Herreros RC, Liu H, Wang R, Liu ZC, Tian X, Wang G, Nan Z, Zhang J, Zai C, Chen W, Gao M, Hu D, Jia S, Li DX, Li Q, Liu SL, Sun Y, Wang B, Xie GF, Xu Z, Yang X, Zhao M, Zhao X, Fang Z, Liu SY, Ma Z, Jiang Y, Zhen Z, Huo F, Yang HG, Miao Y, Yang CM, Chi X, Liu ZX, Zhou S, Zhou FS, Guo R, Jing K, Ren S, Zhao J, Bai H, Cheng C, Cheng J, Hao X, Li H, Li WG, Wang S, Zhang W, Li L, Fu S, Shao J, Tan X, Chen S, Fu J, Zheng Q, Ma J, Chen H, Ma H, Gong L, Zhang Z, Li F, Yang B, Zhou LS, Wang Z, Sun X, Tao G, Wang Q, Guo X, Wang X, Zai K, Cui Q, Fan S, Liu W, Meng Q, Qi G, Qin Y, Wang N, Xu G, Yin X, Zhang Q, Zhang S, Liu R, Wang F, Li WK, Zhang H, Xu X, Ma R, Guan F, Yang T, Zhqo R, Huang J, Li A, Zhou J, You X, Hao L, Zhangfang F, Ma X, Shen C, Hou Z, Zho NF, Huang G, Guo P, Lou J, Wang QP, Jiang X, Li Z, Tian D, Wu ZD, Yang MG, Li ZC, Yang SG, Tu Y, He C, Cao Y, Han Y, Yang JH, Dong S, Li DF, Zhang QF, Fan Z, An DQ, Liu J, Yang G, Xu XC, Xia Y, Xu H, Wang T, Li D, Wei J, Yang P, Liu CY, Shang S, Zhang YG, Leyva EH, Lopez NC, Medina ARG, Kanakakis JE, Nanas JN, Papazoglou PD, Srinivas J, Srinivasulu B, Dani S, Prajapati J, Deepak G, Shallam JF, Nesaraj KJ, Kumar A, Sharma RK, Balasubramaniyan S, Chidambaram N, Umrani R, Chandra S, Dwivedi S, Kishore R, Kumar BJ, Kumble Y, Mehrotra S, Nayak PR, Ramesh SS, Shetty PK, Trivedi SK, Beniwal R, Kalla A, Panwar RB, Alexander KG, Bindu AV, Nambiar A, Barkavi D, Kalanidhi A, Pradeep T, Rajesh J, Ramesh M, Shanmugasundaram S, Kumar P, Sidhu G, Singh R, Pradeep KN, Mittal A, Bijapure JB, Rao MS, Mohanarjun NG, Rao MB, Babu BR, Dinesh N, Jain RK, Jiwani PA, Naik SR, Padmanabhan TNC, Raju BS, Rajaram R, Rao ASVN, Rao D, Rao VSP, Sinha S, Bharani A, Verma G, Tongia RK, Kalra S, Sharma S, Mehrotra R, Sanghvi S, Soni OP, Biswas AD, Boben J, Jacob G, Joseph J, Puri A, Puri VK, Singh H, Calton R, Aneja GK, Nyayadhish P, Nathani PJ, Rane SK, Fulwani M, Jain AS, Khan A, Salkar RG, Somani A, Wadhwani R, Zawar SD, Shegokar VE, Tungikar SL, Vijan V, Trehan R, Garg A, Verma S, Borade S, Duggal D, Hiremath J, Jagdish, Katyal VK, Devendrappa HR, Ratnakar, Latha PB, Manoj EB, Mohanan PP, Gandhimadhinathan P, Jeremaiah K, Raj BSV, Udaysankar R, Chhaparwal JK, Chandy ST, Gupta SN, Raghavan S, Ramesh P, Reddy VS, Srinivas P, Rao KD, Malipeddi BR, Murthy GSR, Joshi R, Patil S, Tredici S, Agnelli D, Assanelli E, Bozzano A, Marsano L, Crivello R, Nejrotti A, Abdulminem A, Saad H, Sanchez JM, Calvillo JC, Hamer A, Ferre JL, Freedman RJ, III NT, Almeida D, Lujan PJC, Mata C, Becerra C, Gonzalez K, Torres F, Alvarez MA, Carrillo E. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: The CREATE-ECLA randomized controlled trial. Journal of the American Medical Association. 2005;293(4):437–446.
Journal cover image

Published In

Journal of the American Medical Association

DOI

ISSN

0098-7484

Publication Date

2005

Volume

293

Issue

4

Start / End Page

437 / 446

Related Subject Headings

  • General & Internal Medicine
  • 11 Medical and Health Sciences