Comparison of Thrombolytic Success in Patients Undergoing Reperfusion Therapy with Streptokinase for ST Elevation Myocardial Infarction, in Terms of Culprit Artery Patency in Diabetics vs Non Diabetics.

Abstract

ABSTRACT

Introduction: Myocardial infarction secondary to atherosclerosis of coronary arteries remains the leading cause of morbidity and mortality worldwide including Pakistan.The aim of thrombolysis in acute MI is prompt and optimal myocardial reperfusion while partial or failed reperfusion is associated with increased risk of complications and adverse outcomes.

Objective: Todetermine the frequency of diabetes mellitus in patients presenting with Acute STEMI and to compare the frequency of culprit artery patency in diabetic vs non diabetic with Acute STEMI

Study Design:Descriptive Cross-sectional Study.

Setting: Cardiology department, Jinnah Hospital Lahore.

Study Duration: From 01-07-2017 to 31-12-2017.

Material and Methods:200 patients with STEMI fulfilling the inclusion criteria were approached andenrolled in the study after obtaining an informed consent. BSR was assessed for every patient at first medical contact . A baseline twelve-lead ECG was recorded before start of streptokinase and culprit artery recorded (as per operational definition). Patients were given streptokinase in a dose of 1.5 million IU over an hour with constant monitoring. Coronary angiogram was done 24 hours post thrombolysis to assess the patency of culprit artery. Frequency of the culprit artery patency was compared between diabetics and nondiabetics by using chi square test considering the p value <0.05 as statistically significant.

Results: Mean age of study population was 46.74 + 9.71 years. The mean BSR was 173.62 + 61.08 mg/dL.Study included 56% (n=112) male patients and 44% (n=88) female patients. 23% (n=46)were diabetics among them. The percentage of culprit artery patency in diabetic patients was lower compared to non diabetics patients(43.5% vs 74.0%, p-value = 0.00). In more than 40 years age group, the culprit artery patency was significantly lower in diabetics compared to non-diabetics (40.5% vs 74.3%, p =0.000).

Conclusion:Thrombolytic success in terms of culprit artery patency was lower in diabetic vs nondiabetic patients and association was observed in both genders and patients of >40 years age. However, in younger patients (<40 years) such association was not found.

Keywords:Myocardial Infarction, Diabetes, Reperfusion Therapy, Culprit Artery Patency.