The effect of diabetic medications on creatine kinase-myocardial band levels in patients undergoing coronary artery bypass surgery

• Published in: Interactive cardiovascular and thoracic surgery 2009-11, Vol.9 (5), p.793-796
• Main Authors: Engoren, Milo, Zacharias, Anoar, Habib, Robert H, Schwann, Thomas A, Riordan, Christopher J, Durham, Samuel J, Shah, Aamir
• Format: Article
• Language: English
• Subjects: Aged; Biomarkers - blood; Blood Glucose - drug effects; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Disease - blood; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Creatine Kinase, MB Form - blood; Diabetes Mellitus - blood; Diabetes Mellitus - drug therapy; Diabetes Mellitus - mortality; Female; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Ischemic Preconditioning; Linear Models; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Myocardial Infarction - prevention & control; Retrospective Studies; Risk Assessment; Time Factors; Treatment Outcome
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2009.211425

Departments of Anesthesiology and Cardiothoracic Surgery, St. Vincent Mercy Medical Center, 2213 Cherry Street, Toledo, OH 43608, USA *Corresponding author. Tel.: [phone]. E-mail address : engoren{at}pol.net (M. Engoren). Ischemic preconditioning has been shown to attenuate the rise in creatine kinase-myocardial band levels that occur with coronary artery bypass surgery (CABG). Recently, concerns have been raised that some sulfonylureas particularly glibenclamide may block ischemic preconditioning. The purpose of this study was to determine the effect of various diabetic medicines on creatine kinase-myocardial band levels after CABG. In this retrospective study of 799 patients undergoing CABG, patients continued their routine diabetic medicines up to the day of surgery. Intra-operatively and postoperatively, tight glycemic control was maintained with an insulin infusion. Anesthesia was maintained with isoflurane supplemented by fentanyl. Creatine kinase-myocardial band levels were determined the day after surgery at 05:00 h and the mean levels compared between diabetics and non-diabetics and further compared by type of diabetic medicine. After univariable comparisons, linear regression was used to determine the statistically significant predictors of creatine kinase-myocardial band levels. After correction for other factors, none of the diabetic medicines was a statistically significant predictor of creatine kinase-myocardial band levels. We found that the use of glibenclamide or other diabetic medications had no effect on creatine kinase-myocardial band levels the morning after patients underwent CABG. Key Words: Ischemic preconditioning; Diabetes mellitus; Sulfonylureas; Coronary artery bypass surgery; Isoflurane; Creatine kinase-myocardial band