Type 2 Diabetes and Intravenous Thrombolysis Outcome in the Setting of ST Elevation Myocardial Infarction

Abstract

OBJECTIVE -There are conflicting results regarding the impact of type 2 diabetes on intravenous thrombolysis effectiveness during ST elevation myocardial infarction (STEMI). The present study, using a continuous 12-lead electrocardiogram, examined the possible association of type 2 diabetes with both acute intravenous thrombolysis effectiveness and long-term prognosis in this setting.RESEARCH DESIGN AND METHODS -The study included 726 consecutive subjects (214 type 2 diabetic subjects) with STEMI who received intravenous thrombolysis in the first 6 h from index pain and were followed up for 3.5 years.RESULTS -Type 2 diabetic subjects had significantly lower incidence of sustained Ն50% ST recovery than nondiabetic subjects (P ϭ 0.03). Additionally, the former required a significantly greater time interval through the achievement of this criterion than the latter (P Ͻ 0.001). In both type 2 diabetic (P Ͻ 0.001) and nondiabetic subjects (P Ͻ 0.001), those who had not attained Ն50% ST recovery were at significantly higher risk of cardiac death than subjects who had reached this criterion. The subjects who attained the above electrocardiographic criterion in Ն60 min after thrombolysis initiation were at significantly higher risk compared with those who achieved this criterion in Ͻ60 min (P ϭ 0.02). However, this association was true only for type 2 diabetic subjects (P ϭ 0.01) and not for nondiabetic subjects (P ϭ 0.9).CONCLUSIONS -The present study suggests that type 2 diabetes is a strong predictor of acute intravenous thrombolysis failure during STEMI. This finding may significantly contribute to the worse prognosis for type 2 diabetic subjects compared with nondiabetic ones in this setting.

A comparative study on the effect of streptokinase between diabetic and non-diabetic myocardial infarction patients

“…By using the same resolution criteria, in our study we observed the similar results in non-diabetic myocardial infarction where 48.4% patients showed complete resolution, 31.7% patient's partial resolution and 19.8% showed failed In our study, more 'complete ST-resolution' was seen in non-diabetic patient (48.4 vs. 19.7%; Z= 4.25; p<0.001) whereas type 2 diabetic subjects were presented with significantly higher incidence of failed ST-resolution than non-diabetic subjects (67.2 vs. 19.8%; Z= 6.79; p<0.001). This significant change in ST-resolution between non-diabetic and diabetic group was similar with the study done by Zairis et al, 2004, who showed significant difference between diabetic and non-diabetic patient in relation to complete (34.1 vs. 68.2%; p<0.001) and incomplete (65.9 vs. 31.8%; p<0.001) resolution.…”

“…Several studies have reported similar angiographic (Angeja et al, 2002;Woodfield et al, 1996) or ECG (Mak et al, 1997;Ishihara et al, 2001) success in both type 2 diabetic and non-diabetic subjects, while others have shown that the diabetics have less complete resolution of ST elevation than the non-diabetics (Angeja et al, 2002;Zairis et al, 2004). To evaluate this issue, it has been hypothesized that type 2 diabetes might interfere with intravenous thrombolysis effectiveness, as estimated by angiographic or ECG criteria.…”

“…But it is the 1 st hour considered golden hour for thrombolytic therapy. The outcome of acute myocardial infarction treated with fibrinolytic therapy can be evaluated either by coronary angiographic measurement of TIMI (Thrombolysis In Myocardial Infarction) blood flow or by the measurement of ST segment resolution at 90 min after streptokinase infusion, in 12 lead electrocardiogram (Zairis et al, 2004). Although successful recanalization of the epicardial vessel is a necessary condition, it is the micro -vascular flow that most strongly correlates with outcome.…”

The influence of type 2 diabetes on fibrin structure and function

“…This implies that the tightly packed clots consisting of thicker fibres with a denser, more cross-linked structure that we have found to be formed by diabetic subjects are more resistant to fibrinolysis. An alteration in clot susceptibility to fibrinolysis, together with the profound suppression of fibrinolysis, due to high levels of the fibrinolytic inhibitor PAI-1, which is associated with type 2 diabetes [39], may be of considerable importance in determining the success of both physiological and pharmacological clot lysis, and may contribute to the increased atherothrombotic risk in these patients; indeed the results of clinical studies have shown type 2 diabetes to be a significant predictor of failure of thrombolytic therapy after myocardial infarction [40]. The mechanism(s) by which the structure of the fibrin clot is influenced by the ambient glucose concentration are as yet undetermined.…”

Intraosseous hemangioma in parietal bone

“…This finding may partly explain the worse clinical outcome in this group of patients 12,22 and is in close agreement with a previous investigation suggesting a low efficiency of thrombolysis among diabetics with ST elevation myocardial infarction. 23 There are various potential clues of explanation for this phenomenon, but it is tempting to speculate about a central role of plasminogen activator inhibitor (PAI). Levels of PAI are substantially elevated in diabetic patients, and this abnormality is not reversed by standard therapy.…”