Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65 - post 67, 2900 Hellerup, Denmark.
Int J Cardiol. 2011 Nov 3;152(3):327-31. doi: 10.1016/j.ijcard.2010.07.027. Epub 2010 Aug 24.
Sulfonylureas have been linked to an increased cardiovascular risk by inhibition of myocardial preconditioning. Whether individual sulfonylureas affect outcomes in diabetic patients after emergent percutaneous coronary intervention for myocardial infarction is unknown.
All Danish patients receiving glucose-lowering drugs admitted with myocardial infarction between 1997 and 2006 who underwent emergent percutaneous coronary intervention were identified from national registers. Multivariable Cox proportional hazards models were used to analyze the risk of cardiovascular mortality and morbidity associated with sulfonylureas.
A total of 926 patients were included and 163 (17.6%) patients died during the first year of which 155 (16.7%) were cardiovascular deaths. The most common treatment was sulfonylureas which were received by 271 (29.3%) patients, and 129 (13.9%) received metformin. Cox proportional hazard regression analyses adjusted for age, sex, calendar year, comorbidity and concomitant pharmacotherapy showed an increased risk of cardiovascular mortality (hazard ratio [HR] 2.91, 95% confidence interval [CI] 1.26-6.72 ; p=0.012), cardiovascular mortality and nonfatal myocardial infarction (HR 2.69 , 95% CI 1.21-6.00; p=0.016), and all-cause mortality (HR 2.46, 95% CI 1.11-5.47; p=0.027), respectively, with glyburide compared to metformin.
Glyburide is associated with increased cardiovascular mortality and morbidity in patients with diabetes mellitus undergoing emergent percutaneous coronary intervention after myocardial infarction. Early reperfusion therapy is the mainstay in modern treatment of myocardial infarction and the time may have come to discard glyburide in favour of sulfonylureas that do not appear to confer increased cardiovascular risk.
磺酰脲类药物通过抑制心肌预处理而与心血管风险增加相关。对于因心肌梗死而行紧急经皮冠状动脉介入治疗（PCI）的糖尿病患者，个体磺酰脲类药物是否会影响结局尚不清楚。
从国家登记处确定了 1997 年至 2006 年期间因心肌梗死入院并接受紧急 PCI 的所有接受降糖药物治疗的丹麦患者。使用多变量 Cox 比例风险模型分析磺酰脲类药物与心血管死亡率和发病率相关的风险。
共纳入 926 例患者，其中 163 例（17.6%）患者在第一年死亡，其中 155 例（16.7%）为心血管死亡。最常见的治疗方法是磺酰脲类药物，有 271 例（29.3%）患者接受了磺酰脲类药物治疗，129 例（13.9%）患者接受了二甲双胍治疗。调整年龄、性别、年份、合并症和同时使用的药物治疗后，Cox 比例风险回归分析显示心血管死亡率（危险比[HR] 2.91，95%置信区间[CI] 1.26-6.72；p=0.012）、心血管死亡率和非致死性心肌梗死（HR 2.69，95%CI 1.21-6.00；p=0.016）以及全因死亡率（HR 2.46，95%CI 1.11-5.47；p=0.027）的风险增加，与二甲双胍相比，格列本脲的风险更高。
对于因心肌梗死而行紧急 PCI 的糖尿病患者，格列本脲与心血管死亡率和发病率增加相关。早期再灌注治疗是现代心肌梗死治疗的主要方法，现在可能是时候摒弃不会增加心血管风险的磺酰脲类药物，转而使用格列本脲了。
