Impact of type of preadmission sulfonylureas on mortality and cardiovascular outcomes in diabetic patients with acute myocardial infarction.
BACKGROUND
The impact of antidiabetic medications on clinical outcomes in patients developing acute myocardial infarction (MI) is controversial. We sought to determine whether in-hospital outcomes in patients who were on sulfonylureas (SUs) when they developed their MIs differed from that of diabetic patients not receiving SUs and whether clinical outcomes were related to the pancreatic cells specificity of SUs.


RESULTS
We analyzed the outcomes of the 1310 diabetic patients included in the nationwide French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction in 2005. Medications used before the acute episode were recorded. In-hospital complications were analyzed according to prior antidiabetic treatment. Mortality was lower in patients previously treated with SUs (3.9%) vs. those on other oral medications (6.4%), insulin (9.4%), or no medication (8.4%) (P = 0.014). Among SU-treated patients, in-hospital mortality was lower in patients receiving pancreatic cells-specific SUs (gliclazide or glimepiride) (2.7%), compared with glibenclamide (7.5%) (P = 0.019). Arrhythmias and ischemic complications were also less frequent in patients receiving gliclazide/glimepiride. The lower risk in patients receiving gliclazide/glimepiride vs. glibenclamide persisted after multivariate adjustment (odds ratio 0.15; 95% confidence interval 0.04-0.56) and in propensity score-matched cohorts.


CONCLUSIONS
In this nationwide registry of patients hospitalized for acute MI, no hazard was associated with the use of SUs before the acute episode. In addition, patients previously receiving gliclazide/glimepiride had improved in-hospital outcomes, compared with those on glibenclamide.
Zeller
Marianne
M
Laboratory of Experimental and Cardiovascular Physiopathology and Pharmacology, Institut Fédératif de Recherche Santé-Sciences et Techniques de l'Information et de la Communication, Faculty of Medicine, 7 Bd Jeanne d'Arc, Dijon, France. marianne.zeller@u-bourgogne.fr
Danchin
Nicolas
N
Simon
Dominique
D
Vahanian
Alec
A
Lorgis
Luc
L
Cottin
Yves
Y
Berland
Jacques
J
Gueret
Pascal
P
Wyart
Pascal
P
Deturck
Régis
R
Tabone
Xavier
X
Machecourt
Jacques
J
Leclercq
Florence
F
Drouet
Elodie
E
Mulak
Geneviève
G
Bataille
Vincent
V
Cambou
Jean-Pierre
JP
Ferrieres
Jean
J
Simon
Tabassome
T
D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D013453:Sulfonylurea Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds