Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction

Kirk N. Garratt, Peter A. Brady, Nancy L. Hassinger, Diane E. Grill, Andre Terzic, David Holmes

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)119-124
Number of pages6
JournalJournal of the American College of Cardiology
Volume33
Issue number1
DOIs
StatePublished - Jan 1999

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Angioplasty
Diabetes Mellitus
Myocardial Infarction
Mortality
Pharmaceutical Preparations
Hospital Mortality
Heart Failure
Cardiac Arrhythmias
Ischemic Preconditioning
Myocardial Reperfusion
Balloon Angioplasty
Ventricular Function
Stroke Volume
Myocardial Ischemia
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction. / Garratt, Kirk N.; Brady, Peter A.; Hassinger, Nancy L.; Grill, Diane E.; Terzic, Andre; Holmes, David.

In: Journal of the American College of Cardiology, Vol. 33, No. 1, 01.1999, p. 119-124.

Research output: Contribution to journalArticle

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abstract = "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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