CLINICAL STUDIES
Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction
Kirk N. Garratt, MD, FACCa,
Peter A. Brady, MD, MRCPa,
Nancy L. Hassinger, MDa,
Diane E. Grilla,
Andre Terzic, MD, PhDa and
David R. Holmes, Jr., MD, FACCa
a Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA
Manuscript received February 19, 1998;
revised manuscript received August 10, 1998,
accepted September 10, 1998.
Address for correspondence: Dr. Kirk N. Garratt, 200 First St. SW, Rochester, Minnesota 55905
Objectives. The purpose of this study was to examine the impact of sulfonylurea drug use on outcome in diabetic patients undergoing direct coronary angioplasty for acute myocardial infarction.
Background. Sulfonylurea drugs impair ischemic preconditioning. Whether sulfonylurea drugs affect outcome adversely in diabetic patients undergoing direct angioplasty for acute myocardial infarction is unknown.
Methods. Clinical outcomes after direct balloon angioplasty for acute myocardial infarction were evaluated in 67 diabetic patients taking oral sulfonylurea drugs and 118 diabetic patients not taking these drugs.
Results. Hospital mortality was significantly higher among diabetics treated with sulfonylurea drugs at the time of myocardial infarction (24% vs. 11%). Univariate analysis identified sulfonylurea drug, age, ventricular function, ejection fraction less than 40%, prior bypass surgery and congestive heart failure as correlates of increased in-hospital mortality. Logistic regression found sulfonylurea drug use (odds ratio 2.77, p = 0.017) to be independently associated with early mortality. Congestive heart failure, but not sulfonylurea drug use, was associated with an increased incidence of in-hospital ventricular arrhythmias. Congestive heart failure, prior bypass surgery and female gender, but not sulfonylurea drug use, were associated with late adverse events.
Conclusions. Sulfonylurea drug use is associated with an increased risk of in-hospital mortality among diabetic patients undergoing coronary angioplasty for acute myocardial infarction. This early risk is not explained by an increase in ventricular arrhythmias, but may reflect deleterious effects of sulfonylurea drugs on myocardial tolerance for ischemia and reperfusion. For surviving patients sulfonylurea drug use is not associated with an increased risk of serious late adverse events.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft surgery | | CI | = 95% confidence interval | | HbgA1C | = glycosylated hemoglobin | | KATP | = adenosine triphosphate–sensitive potassium channel | | LVEF | = left ventricular ejection fraction | | MI | = myocardial infarction | | OR | = odds ratio |
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