Influence of diabetes mellitus on intravenous thrombolysis effectiveness in patients with ST elevation myocardial infarction

Background-Early resolution of ST-segment elevation is associated with enhanced clinical outcome following ST elevation myocardial infarction (STEMI). Despite the improvements in the management of type 2 diabetic patients with STEMI these patients have unfavorable prognosis. The present prospective study investigated the hypothesis that type 2 diabetic patients may have a delayed ST-segment recovery during administration of intravenous thrombolysis even though within the desirable margin. Methods-The study cohort included 137 consecutive patients with STEMI; 105 were non-diabetic and 32 type 2 diabetic. All patients received thrombolysis in r6 hours from index pain and attained steady 250% ST-segment recovery within 90min. The course of ST-segment recovery was assessed utilizing continuous 12.lead electrocardiographic monitoring. Results-The time required for 250% ST-segment steady resolution was significantly greater in type 2 diabetics (P <O.OOi). Additionally, although there was no difference in the mcidence of TIMI 2 or 3 flow between the two groups, type 2 diabetics had significantly higher values of corrected TIMI frame count in the infarct-related arteries (P <O.OOl). By multwariate linear regression analysis diabetes mellitus was independently and positively related to the time for 150% ST-segment recovery (P ~0.001). Conclusions-The present study implies that type 2 diabetic patients may have delayed recovery of ST-segment elevation even dunng successful thrombolysis.