title: Myocardial protection by remote ischaemic pre-conditioning is abolished in sulphonylurea-treated diabetics undergoing coronary revascularisation.
abstract: BACKGROUND
  Remote ischaemic pre-conditioning attenuates myocardial injury. Because sulphonylurea drugs interfere with ischaemic and anaesthetic pre-conditioning, we assessed whether remote ischaemic pre-conditioning effects are altered in sulphonylurea-treated diabetics.
  
  
  METHODS
  Using the database of our ongoing randomised, placebo-controlled study (ClinicalTrials.gov NCT01406678), we assessed the troponin I concentration area under curve (measurements: baseline, 1, 6, 12, 24, 48, and 72 h post-operatively) in sulphonylurea-treated diabetics (n = 27) and non-diabetics (n = 230) without and with remote ischaemic pre-conditioning (three 5-min periods of left upper arm ischaemia with 5-min reperfusion each) during isoflurane anaesthesia before two- to three-vessel coronary artery surgery.
  
  
  RESULTS
  Remote ischaemic pre-conditioning in non-diabetic patients evoked a 41% decrease in the troponin I concentration area under curve (514 ng/ml × 72 h ± 600 vs. 302 ± 190, P = 0.001) but no change (404 ng/ml × 72 h ± 224 vs. 471 ± 383, P = 0.62) in sulphonylurea-treated diabetics. There was no significant correlation between the troponin I concentration area under curve and arterial glucose concentrations, and the latter was not an independent confounder.
  
  
  CONCLUSIONS
  Cardioprotection by remote ischaemic pre-conditioning during isoflurane anaesthesia is abolished in sulphonylurea-treated diabetics.
authors.affiliation: Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Kottenberg
authors.forename: M
authors.initials: M
authors.lastname: Thielmann
authors.forename: P
authors.initials: P
authors.lastname: Kleinbongard
authors.forename: U H
authors.initials: UH
authors.lastname: Frey
authors.forename: T
authors.initials: T
authors.lastname: Heine
authors.forename: H
authors.initials: H
authors.lastname: Jakob
authors.forename: G
authors.initials: G
authors.lastname: Heusch
authors.forename: J
authors.initials: J
authors.lastname: Peters
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D003250:Constriction; D048909:Diabetes Complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D056346:Sternotomy; D013453:Sulfonylurea Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D019210:Troponin I / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D019210:Troponin I