Myocardial protection by remote ischaemic pre-conditioning is abolished in sulphonylurea-treated diabetics undergoing coronary revascularisation

• Published in: Acta anaesthesiologica Scandinavica 2014-04, Vol.58 (4), p.453-462
• Main Authors: KOTTENBERG, E., THIELMANN, M., KLEINBONGARD, P., FREY, U. H., HEINE, T., JAKOB, H., HEUSCH, G., PETERS, J.
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia, General; Area Under Curve; Blood Glucose - metabolism; Cohort Studies; Constriction; Diabetes Complications - therapy; Female; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Ischemic Preconditioning, Myocardial - methods; Male; Mammary Arteries - transplantation; Middle Aged; Myocardial Reperfusion Injury - prevention & control; Myocardial Revascularization - adverse effects; Myocardial Revascularization - methods; Retrospective Studies; Saphenous Vein - transplantation; Sternotomy; Sulfonylurea Compounds - adverse effects; Sulfonylurea Compounds - therapeutic use; Troponin I - metabolism
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/aas.12278

Background Remote ischaemic pre‐conditioning attenuates myocardial injury. Because sulphonylurea drugs interfere with ischaemic and anaesthetic pre‐conditioning, we assessed whether remote ischaemic pre‐conditioning effects are altered in sulphonylurea‐treated diabetics. Methods Using the database of our ongoing randomised, placebo‐controlled study (ClinicalTrials.gov NCT01406678), we assessed the troponin I concentration area under curve (measurements: baseline, 1, 6, 12, 24, 48, and 72 h post‐operatively) in sulphonylurea‐treated diabetics (n = 27) and non‐diabetics (n = 230) without and with remote ischaemic pre‐conditioning (three 5‐min periods of left upper arm ischaemia with 5‐min reperfusion each) during isoflurane anaesthesia before two‐ to three‐vessel coronary artery surgery. Results Remote ischaemic pre‐conditioning in non‐diabetic patients evoked a 41% decrease in the troponin I concentration area under curve (514 ng/ml × 72 h ± 600 vs. 302 ± 190, P = 0.001) but no change (404 ng/ml × 72 h ± 224 vs. 471 ± 383, P = 0.62) in sulphonylurea‐treated diabetics. There was no significant correlation between the troponin I concentration area under curve and arterial glucose concentrations, and the latter was not an independent confounder. Conclusion Cardioprotection by remote ischaemic pre‐conditioning during isoflurane anaesthesia is abolished in sulphonylurea‐treated diabetics.