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Diabetes Care 27:967-971, 2004
© 2004 by the American Diabetes Association, Inc.

Pathophysiology/Complications
Original Article

Type 2 Diabetes and Intravenous Thrombolysis Outcome in the Setting of ST Elevation Myocardial Infarction

Michael N. Zairis, MD, Anastassios G. Lyras, MD, Stamatis S. Makrygiannis, MD, Paraskevi K. Psarogianni, MD, Evdokia N. Adamopoulou, MD, Stelios M. Handanis, MD, Apostolos Papantonakos, MD, Spyros K. Argyrakis, MD, Athanasios A. Prekates, MD and Stefanos G. Foussas, MD

From the Department of Cardiology, Tzanio Hospital, Piraeus, Greece

Address correspondence and reprint requests to Dr. Michael N. Zairis, 40 Acti Themistocleous St., Piraeus, 18537, Greece. E-mail: zairis{at}hellasnet.gr

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 (P < 0.001). 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.

Abbreviations: ECG, electrocardiogram • ROC, receiver operating characteristic • STEMI, ST elevation myocardial infarction


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