COMPARISON OF THE EFFICACY AND SAFETY OF THROMBOLYTIC THERAPY FOR ST-ELEVATION MYOCARDIAL INFARCTION IN PATIENTS WITH AND WITHOUT DIABETES MELLITUS

Abstract

Objective: This study compared the efficacy and safety of streptokinase as
thrombolytic agent for ST-elevation myocardial infarction (STEMI) in patients
with and without diabetes mellitus.
Methodology: This prospective interventional study was carried out in the
department of Cardiology, Postgraduate Medical Institute Govt. Lady Reading
Hospital Peshawar. A total of 444 patients admitted to coronary care unit with
STEMI and eligible for thrombolytic therapy (no contraindications per AHA/ACC
guidelines) were studied from December 2009 to December 2010. Among these
half of patients were diabetic while rests were non-diabetic. Streptokinase was
administered to all patients. Resolution (reduction) of elevated ST segment was
evaluated after 90 min of streptokinase administration. Comlications of
streptokinase infusion including hypotension, shock and hemorrhage was noted.
Results: Failed reperfusion (<30% ST resolution) was significantly higher in
diabetic as compared to non-diabetic patients (21.6% vs. 9.5%; p<0.0003)
while successful reperfusion (≥70% ST-resolution) was significantly higher in
non-diabetic than diabetic patients (66.7% vs. 49.1%; p<0.0001). Complication
rates between the two groups were statistically similar. Hypotension occurred in
45 (20.3%) and 51 (23%); p=0.458 patients in non-diabetic and diabetic group
respectively while shock occurred in 10 (4.5%) and 13 (5.9%); p= 0.506 and
hemorrhagic manifestations in 13 (5.9%) and 10 (4.5%); p=0.294 patients
respectively.
Conclusion: The outcome of thrombolytic therapy is adversely affected by
Diabetes mellitus in patients with ST-elevation myocardial infarction. Secondly
the risk of hazards associated with thrombolytic therapy is same in both diabetic
and non-diabetic patients.