Cor Vasa 2016, 58(6):e584-e590 | DOI: 10.1016/j.crvasa.2015.11.001

The impact of diabetes on electrocardiographic ST resolution and clinical outcome of acute ST elevation myocardial infarction following fibrinolytic therapy

Mir Milad Pourmousavi^a, Arezou Tajlil^a, Behzad Rahimi Darabad^b, Laleh Pourmousavi^a, Leili Pourafkari^c, Samad Ghaffari^a,*

^a Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

^b Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran

^c University at Buffalo, United States

Objective: To investigate the association of diabetes with ST segment resolution and clinical outcomes after fibrinolysis in patients with first ST elevation myocardial infarction (STEMI).

Methods and results: Clinical information from 275 consecutive patients with first STEMI, who received streptokinase within six hours of chest pain initiation, was collected prospectively. ST resolution ≥ 50%, ninety minutes after fibrinolysis was considered as a sign of successful reperfusion. Association of diabetes with the risk of reperfusion failure, development of heart failure and in-hospital mortality was determined before and after controlling for other coronary risk factors.
ST resolution ≥ 50% was present in 45.1% of non-diabetics and 48.7% of diabetics (p = 0.1). Heart failure and in-hospital mortality were more common in diabetics (25.7% vs. 14.8%, p = 0.03 and 17.8% vs. 8.4%, p = 0.03, respectively). Diabetics were more likely to have three-vessel disease in coronary angiography (23% vs. 8%, p < 0.001). After controlling for baseline characteristics, diabetes was not independently associated with reperfusion failure and major adverse cardiac events, including heart failure and in-hospital mortality.

Conclusions: ST resolution is not affected by the presence of diabetes. Although diabetics have higher prevalence of heart failure and in-hospital mortality after treatment of STEMI with streptokinase, their poor outcome is most likely due to higher burden of simultaneous coronary risk factors.

Keywords: Diabetes mellitus; Electrocardiography; Myocardial infarction; Thrombolysis

Received: September 3, 2015; Revised: October 30, 2015; Accepted: November 1, 2015; Published: December 1, 2016  Show citation