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

Objectives. The purpose of this study was to examine the impact of sulfonylure drug use on outcome in diabetic patients undergoing direct coronary angioplasty for acute myocardial infarction. Background. Sulfonylure drugs impair ischemic preconditioning. Whether sulfonylure 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 sulfonylure drugs and 118 diabetic patients not taking these drugs. Results. Hospital mortality was significantly higher among diabetics treated with sulfonylure drugs at the time of myocardial infarction (24% vs. 11%). Univariate analysis identified sulfonylure 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 sulfonylure drug use (odds ratio 2.77, p = 0.017) to be independently associated with early mortality. Congestive heart failure, but not sulfonylure drug use, was associated with an increased incidence of in-hospital ventricular arrhythmias. Congestive heart failure, prior bypass surgery and female gender, but not sulfonylure drug use, were associated with late adverse events. Conclusions. Sulfonylure 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 sulfonylure drugs on myocardial tolerance for ischemi and reperfusion. For surviving patients sulfonylure drug use is not associated with an increased risk of serious late adverse events.