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J Am Coll Cardiol. 2003 Sep 17;42(6):1017-21.

Sulfonylureas attenuate electrocardiographic ST-segment elevation during an acute myocardial infarction in diabetics.

Author information

1
MetroWest Medical Center, Framingham, Massachusetts, USA. jfhuizar@massmed.org

Abstract

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.

PMID:
13678923
DOI:
10.1016/s0735-1097(03)00916-1
[Indexed for MEDLINE]
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