title: Sulfonylurea use is associated with larger infarct size in patients with diabetes and ST-elevation myocardial infarction.
abstract: BACKGROUND
  Animal models have demonstrated that sulfonylureas increase the size of myocardial infarction; however, data in humans is scarce. This study evaluated the association between sulfonylurea use and infarct size in diabetes patients with ST-elevation myocardial infarction (STEMI).
  
  
  METHODS
  Consecutive STEMI patients admitted in Edmonton, Canada between 2006 and 2011 were enrolled in a regional prospective registry program. Patients with type 2 diabetes were identified from this group and the maximum recorded troponin I (max cTnI) within the first 48 h of chest pain onset was used as the primary outcome to quantify infarct size. The relationship between preadmission sulfonylurea use and max cTnI was assessed using multivariable linear regression to adjust for patient demographics, cardiovascular risk factors, clinical data on admission, ischemia time, reperfusion therapy and preadmission drugs.
  
  
  RESULTS
  There were 560 STEMI patients with type 2 diabetes; mean (standard deviation; SD) age was 63.3 (12.8) years, 395 (70.5%) were male, 216 (38.6%) received primary percutaneous intervention, and 211 (37.7%) received thrombolysis. The max cTnI was higher in 146 sulfonylurea users compared to 414 non-sulfonylurea users (mean (SD): 49.8 (74.3) ng/mL versus 39.9 (50.4) ng/mL, respectively; adjusted between-group difference: 12.9 ng/mL; 95% CI 0.3-25.5; p=0.044).
  
  
  CONCLUSIONS
  This study adds further evidence to the proposed causal relationship between sulfonylureas and adverse cardiovascular events by observing a significant difference in infarct size among type 2 diabetes patients presenting with STEMI. Clinicians should consider this association when prescribing sulfonylureas to manage patients with type 2 diabetes.
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.; Alliance for Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, AB, Canada.
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Abdelmoneim
authors.affiliation: Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Welsh
authors.affiliation: Alliance for Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, AB, Canada; Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Dean T
authors.initials: DT
authors.lastname: Eurich
authors.affiliation: Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.; Alliance for Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, AB, Canada. Electronic address: scot@ualberta.ca.
authors.forename: Scot H
authors.initials: SH
authors.lastname: Simpson
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013453:Sulfonylurea Compounds / Q000009:adverse effects*; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D019210:Troponin I
keywords: Infarct size; ST-elevation myocardial infarction; Sulfonylureas; Type 2 diabetes