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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Sulfonylureas attenuate electrocardiographic ST-segment elevation during an acute myocardial infarction in diabetics

Jose F. Huizar, MD^*,*, Luis A. Gonzalez, MD^*, James Alderman, MD, FACC and Harton S. Smith, MD, FACC

^* MetroWest Medical Center, Framingham, Massachusetts, USA
State University of New York, Upstate Medical University Hospital, Syracuse, New York, USA
Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Heart Center of MetroWest, Framingham, Massachusetts, USA

^* Reprint requests and correspondence: Dr. Jose F. Huizar, Upstate Medical University Hospital, State University of New York, Cardiovascular Division, 750 East Adams Street, Syracuse, New York 13210, USA.
jfhuizar{at}massmed.org
huizarj{at}upstate.edu

OBJECTIVES: The aim of this study was to determine whether sulfonylureas attenuate ST-segment elevation in diabetics during acute myocardial infarction (AMI).

BACKGROUND: Sulfonylureas block adenosine triphosphate-sensitive potassium channels found in the pancreas and heart. Animal studies have demonstrated that opening of these cardiac channels results in ST-segment elevation during AMI, and pretreatment with sulfonylureas blunts these ST-segment changes.

METHODS: We performed a retrospective study of diabetic patients hospitalized with AMI over a four-year period in Framingham, Massachusetts. Electrocardiograms obtained on arrival were analyzed for standard ST-segment criteria for thrombolytic therapy (>1 mm in two or more contiguous leads). Results were compared between the study group (40 patients taking sulfonylureas) and control group (48 patients taking alternative hypoglycemic agent).

RESULTS: Demographics were similar for both groups apart from a female preponderance in the study group. A significantly higher percentage of patients in the study group did not meet ST-segment criteria for thrombolytic therapy as compared with the control group (53% vs. 29%, p = 0.02). This difference was most prominent in patients with peak creatinine phosphokinase levels between 500 and 1,000 mg/dl (86% vs. 22%, p = 0.04). The magnitude of ST-segment elevation and the frequency of thrombolytic therapy were significantly lower in the sulfonylurea group than in the control group (1.1 ± 1.0 mm vs. 2.1 ± 2.7 mm, p = 0.02 and 20% vs. 40%, p = 0.04, respectively).

CONCLUSIONS: Sulfonylurea therapy appears to attenuate the magnitude of ST-segment elevation during an AMI, resulting in failure to meet criteria for thrombolytic therapy and as a consequence leading to inappropriate withholding therapy in this subset of diabetic patients.

Abbreviations and Acronyms   ADP   adenosine diphosphate   AMI   acute myocardial infarction   ATP   adenosine triphosphate   CPK   creatinine phosphokinase   ECG   electrocardiogram   K+   potassium   KATP   adenosine triphosphate-sensitive potassium

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