Sulfonylureas are not associated with increased mortality in diabetics treated with thrombolysis for acute myocardial infarction

Background: Sulfonylurea compounds may impair ischemic preconditioning and endogenous fibrinolysis. Increased mortality has been reported in diabetics receiving these drugs prior to admission for acute myocardial infarction w hen treated by direct angioplasty. Although thrombolytics are currently emp loyed far more frequently than direct angioplasty the effect of sulfonylure as on mortality in the setting of thrombolysis has not been previously addr essed. Methods: Two hundred forty five diabetics treated with either accelerated t -PA or streptokinase in a national, multi-center, randomized comparison of argatroban vs. heparin (n=1200) were grouped by anti-diabetic treatment pri or to hospitalization, and their outcomes were compared by retrospective an alysis. Results: Baseline characteristics were similar in all groups (sulfonylureas : n=121, oral medications other than sulfonylureas: n=17, insulin: n=28, di et alone: n=79). Sulfonylurea use was not associated with increased mortali ty or adverse event rates. By logistic regression analysis with diet treatm ent as reference, only prior insulin use was associated with higher risk fo r mortality at 30 days and 1 year (odds ratios 4.5 and 5.22, respectively, p <0.05). Conclusions: Sulfonylureas use prior to admission is not associated with ad verse outcomes in diabetics treated with thrombolytics for myocardial infar ction. Since direct angioplasty may increase mortality in patients taking t hese drugs, a randomized trial is needed to specifically compare different strategies of acute reperfusion in diabetics. Abbreviated abstract. Increased mortality has been reported in diabetics us ing sulfonylureas when treated for myocardial infarction by direct angiopla sty. No study has specifically addressed the effect of these drugs on outco mes in the setting of thrombolysis. In a retrospective analysis of 245 diab etics treated with thrombolysis in a randomized comparison of argatroban vs . heparin, outcomes were compared in relation to anti-diabetic therapy prio r to admission. Sulfonyl-urea use did not adversely affect prognosis, which was worst among diabetics previously treated with insulin. In conclusion, sulfonylureas do not worsen outcomes of diabetics treated with current thro mbolytic regimens in comparison with other anti-diabetic treatments.