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J Am Coll Cardiol, 2003; 42:1017-1021, doi:10.1016/S0735-1097(03)00916-1 © 2003 by the American College of Cardiology Foundation |
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* 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.
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