Predicting clinical outcome in diabetics vs. non diabetics with acute myocardial infarction after thrombolysis, using ECG as a tool

Objectives: To compare, the post Myocardial Infarction in-patient outcome after thrombolytic therapy in diabetics and non diabetics, in a South Asian population. Methods: This was a prospective cross sectional study done at the Punjab Institute of Cardiology, Lahore from January to July 2009. Consecutive patients with ST elevation myocardial infarction, who were not treated with primary angioplasty but were thrombolysed were recruited at the time of arrival in the emergency department. Streptokinase was administered to all patients as the agent for thrombolysis. ECG was taken at baseline and at 60 minutes post streptokinase administration. Patients were subsequently divided into two groups: (A) Non Diabetics, (B) Diabetics. This cohort was followed up through the in hospital stay for major complications which were recurrent ischaemic chest pain,heart failure, arrhythmias and death. Results: A total of 182 patients were included in the study, 146 males and 36 females. In non diabetic group, ST segment resolution occurred in 74 (84%) out of 88 patients and in diabetics, 13 (13.8%) out of 94 patients. In non diabetics, complications developed in 29 (32.9%) out of 88 patients and in diabetics, 75 (79.8%) out of 94 patients (p< 0.001). Diabetes with incorporate ST resolution compared to complete resolution were found to have more in hospital complications such as: recurrent chest pain (71.6% vs 23%, p < 0.0001), heart failure (39.5% vs 15.3%, p= 0.0007), arrhythmias (59.2% vs 15.3%, p < 0.0001), mortality (7.4% vs 0%, p= 0.0082). A similar trend was observed in non diabetics: recurrent chest pain (57.1% vs 17.5%, p < 0.0001), heart failure (42.8% vs 14.8%, p= 0.0002) and arrhythmias (50% vs 12.1%, p < 0.0001). Significant interaction was seen between diabetic status and ST segment resolution with respect to clinical outcome (recurrent chest pain p < 0.0001, heart failure p = 0.025, arrhythmias p < 0.0001, and death p = 0.014). Conclusion: Diabetics with Acute Myocardial Infarction (AMI) encounter more adverse clinical outcome as predicted by incomplete ST resolution after thromboysis.