A COMPARATIVE STUDY OF THROMBOLYSIS OUTCOME IN PATIENTS WITH ST-SEGMENT ELEVATED MYOCARDIAL INFARCTION WITH AND WITHOUT DIABETES MELLITUS

Abstract

Diabetes mellitus is a multifactorial metabolic disorder and causes life-threatening medical emergency of ST-segment elevation myocardial infarction (STEMI) resulting in the blockage of coronary artery leading to myocardial ischemia and subsequent necrosis. Diagnosing STEMI through ECG is a reliable and cost effective as soon a patient is admitted in emergency room. Thrombolysis outcomes of ST-segment resolution in elevated ST-segment myocardial infarction patients with and without diabetes might reduce the mortality and morbidity. Therefore, the study finding may significantly contribute to the prognosis between diabetes and non-diabetes STEMI patients. The total sample size was 100 patients with ST-segment elevated myocardial infarction. There were 60 patients with diabetes and 40 patients without diabetes. Thorough investigation was done through ECG, CK-MB, Troponin-I, RBS, HbA1C, LFT, RFT, CBC, PT/INR and Lipid profile. It was observed that failed thrombolysis represented by lesser than 30% ST resolution was higher among the diabetic STEMI patients when compared to non-diabetes and STEMI patients. Successful thrombolysis (>70% ST resolution) was more in non-diabetic than diabetic STEMI patients. Majority of the subjects belonged to 51-60 years of age group followed by 61-70 years and 41-50 years age group. The study population consisted of 60 males and 40 females. As per the site of MI, anterior wall constituted more frequency in both diabetic and non-diabetic groups, followed by inferior wall comes second and anteroseptal constitutes the least. Chest pain was the most common mode of presentation, present in 95% cases associated with sweating in 86% cases, breathlessness seen in 25% cases. Syncope was seen in 10% cases and palpitation in 5% cases. Frequency of in-hospital complications was more in failed ST resolution compared to complete ST resolution, in both diabetics and non-diabetics, post thrombolysis. In conclusion, diabetic patients were more prone to risks of failed ST resolution, adverse outcome; irregular microvascular stream that may contribute to more unfortunate results saw in patients with diabetes and intense myocardial localized necrosis.

Key Words: Thrombolysis, St-Segment elevation , Myocardial Infarction, Diabetes Mellitus