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Type 2 diabetes and intravenous thrombolysis outcome in the setting of ST elevation myocardial infarction
Michael N Zairis1, Anastassios G Lyras, Stamatis S Makrygiannis
1Department of Cardiology, Tzanio Hospital, Piraeus, Greece. zairis@hellasnet.gr
Insights
Type 2 diabetes reduces the effectiveness of intravenous thrombolysis for ST-elevation myocardial infarction (STEMI). Diabetic patients experienced poorer ST recovery and worse long-term outcomes, indicating higher cardiac death risk.
Area of Science:
- Cardiology
- Diabetology
- Clinical Research
Background:
- Conflicting data exists on type 2 diabetes' impact on ST-elevation myocardial infarction (STEMI) treatment.
- Intravenous thrombolysis is a key reperfusion therapy for STEMI.
Purpose of the Study:
- To investigate the association between type 2 diabetes and the effectiveness of acute intravenous thrombolysis in STEMI patients.
- To assess the long-term prognosis of type 2 diabetic patients undergoing thrombolysis for STEMI.
Main Methods:
- A continuous 12-lead electrocardiogram was used.
- 726 STEMI patients receiving intravenous thrombolysis within 6 hours of symptom onset were included.
- Follow-up was conducted for 3.5 years.
Main Results:
- Type 2 diabetic patients showed significantly lower ST recovery rates (≥50%) and longer time to achieve recovery compared to non-diabetic patients.
- Failure to achieve ≥50% ST recovery was linked to higher cardiac death risk in both groups.
- Delayed ST recovery (≥60 min) increased cardiac death risk, particularly in type 2 diabetic patients.
Conclusions:
- Type 2 diabetes is a significant predictor of acute intravenous thrombolysis failure in STEMI.
- This failure contributes to the worse long-term prognosis observed in type 2 diabetic STEMI patients.
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 > or = 50% ST recovery than nondiabetic subjects (P = 0.03). Additionally, the former required a significantly greater time interval through the achievement of this criterion than the latter (P < 0.001). In both type 2 diabetic (P < 0.001) and nondiabetic subjects (P < 0.001), those who had not attained > or = 50% 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 > or = 60 min after thrombolysis initiation were at significantly higher risk compared with those who achieved this criterion in <60 min (P = 0.02). However, this association was true only for type 2 diabetic subjects (P = 0.01) and not for nondiabetic subjects (P = 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.
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