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

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Abstract
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±3mg.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 kinaseMBactivity were higher in non-diabetic patients (PConclusions 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.

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