Sulfonylureas attenuate electrocardiographic ST-segment elevation during an acute myocardial infarction in diabetics

J Am Coll Cardiol. 2003 Sep 17;42(6):1017-21. doi: 10.1016/s0735-1097(03)00916-1.


Objectives: The aim of this study was to determine whether sulfonylureas attenuate ST-segment elevation in diabetics during acute myocardial infarction (AMI).

Background: Sulfonylureas block adenosine triphosphate-sensitive potassium channels found in the pancreas and heart. Animal studies have demonstrated that opening of these cardiac channels results in ST-segment elevation during AMI, and pretreatment with sulfonylureas blunts these ST-segment changes.

Methods: We performed a retrospective study of diabetic patients hospitalized with AMI over a four-year period in Framingham, Massachusetts. Electrocardiograms obtained on arrival were analyzed for standard ST-segment criteria for thrombolytic therapy (>1 mm in two or more contiguous leads). Results were compared between the study group (40 patients taking sulfonylureas) and control group (48 patients taking alternative hypoglycemic agent).

Results: Demographics were similar for both groups apart from a female preponderance in the study group. A significantly higher percentage of patients in the study group did not meet ST-segment criteria for thrombolytic therapy as compared with the control group (53% vs. 29%, p = 0.02). This difference was most prominent in patients with peak creatinine phosphokinase levels between 500 and 1,000 mg/dl (86% vs. 22%, p = 0.04). The magnitude of ST-segment elevation and the frequency of thrombolytic therapy were significantly lower in the sulfonylurea group than in the control group (1.1 +/- 1.0 mm vs. 2.1 +/- 2.7 mm, p = 0.02 and 20% vs. 40%, p = 0.04, respectively).

Conclusions: Sulfonylurea therapy appears to attenuate the magnitude of ST-segment elevation during an AMI, resulting in failure to meet criteria for thrombolytic therapy and as a consequence leading to inappropriate withholding therapy in this subset of diabetic patients.

MeSH terms

  • Aged
  • Diabetes Complications
  • Diabetes Mellitus / physiopathology*
  • Electrocardiography / drug effects*
  • Female
  • Humans
  • Male
  • Myocardial Infarction / complications
  • Myocardial Infarction / physiopathology*
  • Retrospective Studies
  • Sulfonylurea Compounds / pharmacology*


  • Sulfonylurea Compounds