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Thrombolytic therapy in diabetic patients with acute myocardial infarction
H H Hansen1, S C Kjaergaard, I Bülow
1Department of Cardiology, Aalborg Hospital, Denmark.
Insights
Diabetic patients with acute myocardial infarction (MI) received less thrombolytic therapy than nondiabetic patients. Late hospital arrival was the primary reason for undertreatment in diabetic individuals.
Area of Science:
- Cardiology
- Diabetology
- Public Health
Background:
- Diabetic patients often have worse outcomes following acute myocardial infarction (MI).
- Thrombolytic therapy is a critical treatment for acute MI, improving patient outcomes.
Purpose of the Study:
- To compare thrombolytic therapy rates in diabetic versus nondiabetic patients with acute MI.
- To identify reasons for the underutilization of thrombolytic therapy in diabetic patients.
Main Methods:
- Retrospective study design.
- Analysis of acute myocardial infarction (MI) patients admitted to a coronary care unit over a 3-year period.
- Comparison of thrombolytic therapy administration between diabetic and nondiabetic cohorts.
Main Results:
- Diabetic patients received thrombolytic therapy significantly less often (35%) than nondiabetic patients (47%).
- Late hospital arrival ( > 12 hours post-symptom onset) was the main reason for not receiving thrombolytic therapy in diabetic patients (60%).
- Mortality was higher (29%) in diabetic patients who arrived late and did not receive thrombolytic therapy.
Conclusions:
- Diabetic patients with acute MI are significantly undertreated with thrombolytic therapy compared to their nondiabetic counterparts.
- Late presentation to the hospital is the primary barrier to thrombolytic therapy for diabetic patients experiencing acute MI.
Objective:
To compare the frequency of thrombolytic therapy in diabetic and nondiabetic patients with acute myocardial infarction (MI) and to examine why some diabetic patients do not receive thrombolytic therapy.
Research Design And Methods:
Retrospective study of all diabetic patients with acute MI admitted to the coronary care unit of Aalborg Hospital within a 3-year period.
Results:
Only 35% (43 of 123) of patients with diabetes compared with 47% (404 of 856) of patients without diabetes received thrombolytic therapy (P < 0.002). There was no difference in the percentage of patients thrombolyzed among patients admitted to the hospital within 12 h after onset of symptoms. Of diabetic patients who were not thrombolyzed, 60% (48 of 80) arrived at the hospital later than 12 h after onset of symptoms. Among patients who arrived late, 63% (35 of 56) had Q wave infarction and 84% (47 of 56) had symptoms typical of acute MI. Mortality was 29% (16 of 56) in this group. Only one patient did not receive thrombolytic therapy due to diabetic retinopathy.
Conclusions:
Significantly fewer diabetic patients received thrombolytic therapy compared with patients without diabetes. The main reason diabetic patients did not receive thrombolytic therapy was late arrival to the hospital.