Sulfonylurea 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 sulfonyl urea drug use on outcome in diabetic patients undergoing direct coronary an gioplasty for acute myocardial infarction. Background. Sulfonylurea drugs impair ischemic preconditioning. Whether sul fonylurea drugs affect outcome adversely in diabetic patients undergoing di rect angioplasty for acute myocardial infarction is unknown. Methods. Clinical outcomes after direct balloon angioplasty for acute myoca rdial infarction were evaluated in 67 diabetic patients taking oral sulfony lurea drugs and 118 diabetic patients not taking these drugs. Results. Hospital mortality was significantly higher among diabetics treate d with sulfonylurea drugs at the time of myocardial infarction (24% vs. 11% ). Univariate analysis identified sulfonylurea drug, age, ventricular funct ion, ejection fraction less than 40%, prior bypass surgery and congestive h eart failure as correlates of increased in-hospital mortality. Logistic reg ression found sulfonylurea drug use (odds ratio 2.77, p = 0.017) to be inde pendently associated with early mortality. Congestive heart failure, but no t sulfonylurea drug use, was associated with an increased incidence of in-h ospital ventricular arrhythmias. Congestive heart failure, prior bypass sur gery 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 angioplas ty 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. F or surviving patients sulfonylurea drug use is not associated with an incre ased risk of serious late adverse events. (C) 1998 by the American College of Cardiology.