Abstract
Aims: This retrospective study assessed the association between sulfonylureas use and infarct size in patients with type 2 diabetes (T2DM) and ST-segment elevation myocardial infarction (STEMI) by myocardial enzymology indexes and cardiac magnetic resonance (CMR) imaging.Methods: Patients presenting STEMI between July 2013 and August 2019 were included in a retrospective database at our institution. Antidiabetic agents used before STEMI were recorded. Patients with maximum recorded troponin I (max cTNI) and creatine phosphokinase isoenzyme (CK-MB) within the first 72 h of chest pain onset were selected. Infarct size was quantified by CMR imaging, and cardiovascular outcomes were also obtained at 30 days and 6 months follow-up. Multivariable regression models explored potential risk factors associated with infarct size and clinical outcomes.Results: A total of 254 T2DM and STEMI patients were included, with 101 sulfonylurea users and 153 non-users. Sulfonylureas users were not associated with higher max cTnI and max CK-MB compared to non-users. Among 65 CMR patients, no significant differences in infarct size were detected between sulfonylureas users and non-users. Whereas, the incidence of microvascular obstruction (MVO) was higher in patients receiving sulfonylureas than those taking non-sulfonylureas (88.0 vs. 62.5%, p = 0.023). No higher cardiovascular events of sulfonylureas users vs. non-users were observed, except for heart failure events (24.0 vs. 2.5% at 30 days, p = 0.011; 28.0 vs. 2.5% at 6 months, p = 0.004). Multivariable regression analyses verified that sulfonylureas users increased the risks of MVO.Conclusions: Sulfonylureas use did not associate with larger infarct size in patients with T2DM and STEMI. A potentially higher incidence of MVO in sulfonylurea users was found. Notably, since most patients presented after a relatively long period of ischemia and glibenclamide was not used by the included patients in this observational study, the results of this study should not be extrapolated to clinical settings with short periods of ischemia or to patients using glibenclamide.
Highlights
Type 2 diabetes mellitus (T2DM) is a severe metabolic condition characterized by relative insulin deficiency caused by pancreatic β-cell dysfunction and insulin resistance [1]
cardiac magnetic resonance (CMR) imaging was performed in 65 patients to determine the infarct size, among which 25 patients received sulfonylureas and 40 patients received other antidiabetic agents
Baseline characteristics of the total population were relatively comparable between sulfonylurea and non-sulfonylurea users, except for body weight mass index (BMI), diabetic duration, chronic kidney disease, anterior infarction, and insulin (p < 0.05 for each variable) (Table 1)
Summary
Type 2 diabetes mellitus (T2DM) is a severe metabolic condition characterized by relative insulin deficiency caused by pancreatic β-cell dysfunction and insulin resistance [1]. Diabetes mellitus (DM) is a significant risk factor for acute myocardial infarction (AMI) and about 30% comorbidity in patients hospitalized with AMI. The extensive clinical application of sulfonylureas has raised concerns on the risk of adverse cardiovascular events, initially presented in the University Group Diabetes Program (UGDP) study in 1970 [8]. Sulfonylureas were believed to disrupt the protective effects of ischemic conditioning and subsequently increase infarct size and reduce left ventricular function [9, 10], while two recent randomized controlled trials comparing sulfonylureas with either pioglitazone (TOSCA trial) or linagliptin (CAROLINA trial) failed to observe a higher risk for cardiovascular events with sulfonylureas treatment [11, 12]. Cardiac magnetic resonance (CMR) imaging is a more appropriate and precise method to quantify infarct size in patients with
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