Project Description

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
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 (P0.001). In both type 2 diabetic (P  0.001) and nondiabetic subjects (P  0.001), those who had not attained
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
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.