Noninvasive assessment of prognosis after acute myocardialinfarction in diabetic and non-diabetic patients

الملخص EN

-Background : Diabetes mellitus constitutes an additional risk for patients with acute myocardial infarction (AMI).

The present study aimed to evaluate the impact of diabetes on the prognosis after AMI through noninvasive assessment of the major determinants of adverse outcomes post-infarction in diabetic and non-diabetic patients.

Patients and Methods : The study was conducted on 32 patients presenting with their first STEMI, all of whom received thrombolytic therapy using streptokinase within 6 hours from symptom onset.

Patients were chosen to form 2 groups ; group A : included 16 diabetic patients and group B: included 16 non-diabetic patients.

Using some of the prognostic parameters derived from clinical, laboratory, electrocardiographic and echocardiographic examinations and, when performed, post-discharge exercise ECG stress testing, the baseline characteristics, the course and the clinical outcome were compared in both groups.

Results: Compared to non-diabetics, diabetic patients had significantly larger infarct size, in terms of larger number of leads showing STsegment elevation in the admission ECG (p = 0.

013) and a higher enzymatic infarct size, as measured by peak creatine kinase (CK) and CK-MB (p = 0.

022 and p = 0.

020; respectively).

In addition, they were less likely to have complete ST-segment resolution (STR) at 180 minutes after the initiation of thrombolytic therapy (p = 0.

004).

Moreover, they had significantly lower left ventricular (LV) ejection fraction (p = 0.

013), higher resting wall motion score index (p = 0.

009) and higher prevalence of restrictive LV filling pattern (p = 0.

028).

During a follow up period of at least six months, diabetic patients were less likely to have event-free survival (p = 0.

012).

Using univariate analysis, predictors of outcome after AMI were the presence of diabetes, levels of fasting and 2-hour postprandial blood glucose, time to treatment, peak CK-MB level, anterior infarction, ejection fraction, the presence of restrictive LV filling pattern and the achievement of complete STR.

However, after adjustment for other confounding factors, the only variable which retained its significance was the achievement of complete STR (adjusted OR = 0.

032, 95 % CI = 0.

002-0.

619, p = 0.

023).

Conclusions: From this study, it can be concluded that a greater proportion of diabetic patients fail to achieve normal myocardial perfusion after thrombolytic therapy, a finding associated with higher morbidity and mortality in this patient cohort.

In addition, achievement of complete STR is an independent factor for event free survival after AMI.