A Comparative Study to Assess the Efficacy of Streptokinase in Diabetic Versus Non-Diabetic Acute ST Elevation Myocardial Infarction Patients

Abstract

Objective: Prominent resolution in the ST segment elevation on electrocardiogram(ECG), thrombolysis at the infarction site restoring perfusion determines the effectiveness of the streptokinase therapy. Hyper- coagulable states and lack of efficacy with streptokinase is seen in diabetics. This study aimed to assess the thrombolytic efficacy of streptokinase in diabetic vs non-diabetics patients. Methods: A cross-sectional study was conducted at Cardiology Department of Allama Iqbal Memorial Teaching Hospital, Sialkot from 1st September 2019 to 30th April, 2020. Total 504 patients of which 185 diabetics and 319 non-diabetic were selected. All the patients presenting with first episode of acute ST- elevation myocardial infarction were thrombolysed with 1.5million units of streptokinase within 12hours from the onset of their typical chest pain symptoms. A complete record of ECG changes was kept before and 90 min after thrombolysis with streptokinase. Chi- square test was applied and p value <0.05 was considered significant. Results: 89.19% diabetic patients had >70% resolution of ST segment changes in comparison to 95.61% non-diabetics. 16.76% of the diabetic patients had increased ST-segment elevation post thrombolysis (P- value 0.001). 8.11% and 10.81% reinfarction rates during hospital stay and at one month post-thrombolysis were recorded in diabetics. Reduced left ventricle Ejection Fraction was seen in 62.16% and 58.62% of the diabetic and non-diabetic patients(P-value<0.005). Conclusion: Comparatively decreased efficacy of streptokinase is seen in diabetic patients with reduced resolution of ST-segment. In correspondence with reduced left ventricle EF, re-infarction and stroke episodes. Key Words: Streptokinase, acute myocardial infarction, STEMI, diabetes mellitus, hypercoagulability, atherosclerosis. How to Cite: Hassan Z., Rana N., Rana B., Iqbal I., Chughtai J.I. A comparative study to assess the efficacy of streptokinase in diabetic versus non-diabetic acute ST elevation myocardial infarction patients. Esculapio 2021;17(01):88-92