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Myocardial protection by remote ischaemic pre‐conditioning is abolished in sulphonylurea‐treated diabetics undergoing coronary revascularisation
Author(s) -
KOTTENBERG E.,
THIELMANN M.,
KLEINBONGARD P.,
FREY U. H.,
HEINE T.,
JAKOB H.,
HEUSCH G.,
PETERS J.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12278
Subject(s) - medicine , isoflurane , anesthesia , cardioprotection , cardiology , ischemia , placebo , troponin , myocardial infarction , alternative medicine , pathology
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 ( C linical T rials.gov NCT 01406678), 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.