Myocardial infarction in diabetic vs non-diabetic subjects - Survival and infarct size following therapy with sulfonylureas (glibenclamide)

Aims Sulfonylureas may interfere with 'ischaemic preconditioning' and worsen the prognosis in diabetic patients with acute myocardial infarction. Methods and Results Three hundred and fifty-seven non-diabetic patients admitted with acute myocardial infarction to one hospital over 6.5 years (72 deaths, in-hospital mortality 20.2%) were compared to 245 Type 2 diabetic patients categorized as having taken sulfonylureas (glibenclamide 7 +/- 3 mg . day(-1); n = 76, 25 deaths = 32.9%; P = 0.025), not having taken sulfonylureas (n = 89, 29 deaths = 33.0%; P = 0.012), and newly diagnosed as having diabetes (n = 80, 20 deaths = 25.0%). Survival was significantly different (log-rank test: P = 0.03). Increments in creatine kinase and creatine kinase(MB) activity were higher in non-diabetic patients (P < 0.01). Conclusions In-hospital mortality in Type 2 diabetic patients is higher than in non-diabetic patients suffering acute myocardial infarction regardless of whether or not they had been treated with sulfonylureas. Glibenclamide does not enlarge myocardial necroses. (C) 2000 The European Society of Cardiology.