EFFICACY OF THROMBOLYSIS (STREPTOKINASE) IN DIABETIC AND NON-DIABETIC PATIENTS PRESENTING WITH ACUTE ST ELEVATION MI & COMPARISON OF THEIR ANGIOGRAPHIC PROFILE.

Abstract

BACKGROUND: To determine the efficacy of streptokinase in diabetic versus non-diabetic patients presenting with acute ST Elevation Myocardial Infarction (STEMI). METHOD AND RESULTS: This is a hospital based observational study conducted in the department of Cardiology, S.M.S. MEDICAL COLLEGE and associated hospital, Jaipur, Rajasthan between March 2016 to August 2017. Two hundred one consecutive patients of acute STEMI admitted to the Cardiology department were enrolled in the study to maintain 95% CI and 80% power of study. Patients with acute STEMI within 12 hours of chest pain without contraindications to fibrinolytic therapy (streptokinase) were included. ECG was done before and at 90 minutes after the start of streptokinase. ST-segment resolution equal to or more than 70% at 90 minutes on ECG was taken as successful reperfusion. The data was analysed by using software SPSS version 10. The quantitative variables were presented as mean and standard deviation while qualitative variables as frequency and percentage. Chi square test was used to estimate significance and p-value of <0.05 was considered significant. Out of 201 patients, 127(63.2%) were non-diabetics and 74(36.8%) were diabetics. The age of presentation of these patients was 32-75yr (meanage=55.59yr). Of these patients, 80% (N=160) were male and 20% (N=40) were female. Among the 74 diabetic patients, streptokinase was not effective in any patients. So streptokinase is non-efficacious in diabetic patients. Among the 127 non diabetic patients, streptokinase was effective in 79 (62.2%). Among the risk factors, smoking and hypertension were found in 84.6% and 62.7% of the patients respectively. So, we found smoking as the most common risk factor followed by HTN and DM in our patients. HTN was found significantly more in diabetic patients (94.59%) vs (44.09% in non-diabetic patients). On angiography, 58.7% patients had SVD, 34.8% had DVD and 6.5% had TVD. Five (2.5%) of these were found to have LM disease. Coronary angiography showed SVD, DVD, TVD in 44(59.46%), 17(22.97%) and 13(17.57%) of diabetic vs 74(58.27%), 53(41.73%) and 0(0%) of non-diabetic patients. So, triple vessel disease is significantly higher in diabetic patients. CONCLUSION: This study shows that streptokinase is significantly more efficacious in non-diabetics as compare to diabetic patients presenting with acute STEMI. It is more efficacious in male than female (M=47.82%; F=5%). We found that the window period of presentation was significantly higher in diabetic patient because of atypical symptoms that may lead to a delay in seeking medical advice and streptokinase was significantly more efficacious in non-diabetics as compare to diabetic patients.