title: Thrombolytic effect of streptokinase infusion assessed by ST-segment resolution between diabetic and non-diabetic myocardial infarction patients.
abstract: BACKGROUND
  Recently, it has been hypothesized that type 2 diabetes might interfere with acute intravenous thrombolysis effectiveness as estimated by angiographic or electrocardiographic criteria. In our study, we compared the thrombolytic effect of streptokinase infusion between diabetic and non-diabetic myocardial infarction (MI) patients.
  
  
  METHODS
  In a prospective interventional study, 240 consecutive patients who were admitted to the emergency ward and diagnosed with ST-elevation MI (STEMI) were enroled and classified into diabetics (n = 85) and non-diabetics (n = 155). Streptokinase was given to each patient at a dose of 1.5 million units in 1 h. Twelve-lead ECG was recorded immediately before the start of thrombolytic therapy and at 180 min afterwards for the patients with STEMI. The ST-segment elevation resolution was calculated and stratified as complete resolution ( > 70% ST-resolution), partial resolution (30-70% ST-resolution), or failed resolution ( < 30% ST-resolution).
  
  
  RESULTS
  Complete ST-resolution occurred in 31.6% of diabetic and 51.0% of non-diabetic patients, respectively (p < 0.001). The incidence of partial ST-resolution in diabetic and non-diabetic patients was 40.5% and 40.0%, whereas 27.8% of patients in the diabetic group and 9.0% of patients in the non-diabetic group showed failed ST resolution. ST-resolution was independent of the location of MI. Multivariate analysis showed that diabetes mellitus, as well as higher Killip class and lower ejection fraction, could effectively predict ST-resolution failure.
  
  
  CONCLUSIONS
  Failure of ST-segment resolution 180 min after streptokinase infusion is notably higher in diabetic vs non-diabetic patients. This failure rate is correlated with higher Killip class and lower ejection fraction.
authors.affiliation: Kerman Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran. cardiology_thc@yahoo.com
authors.forename: Mohammad
authors.initials: M
authors.lastname: Masoomi
authors.forename: Sadra
authors.initials: S
authors.lastname: Samadi
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Sheikhvatan
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007492:Iran / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013300:Streptokinase / Q000008:administration & dosage*; D013318:Stroke Volume; D015912:Thrombolytic Therapy; D013997:Time Factors; D017211:Treatment Failure; D016277:Ventricular Function, Left
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase