RESUMO
To determine clinical predictors of in-hospital complications in patients presenting with acute ST elevation myocardial infarction. Descriptive Study. from October 2010 to January 2011. Faisalabad Institute of CardioIogy Faisalabad. A total 342 patients with AMI were recruited in this study. All patients presenting with acute ST elevation myocardial infarction and fulfilling inclusion and exclusion criteria were included in the study. A full history was taken, particularly age, sex occupation, address, history of smoking, diabetes mellitus, hypertension, ischemic heart disease and family history of ischemic heart diseases Primary end point was death while secondary end point were patients who had mechanical, ischemic or electrical complications or all of them Mean age of the study population was 56.3 +/- 12.7 years. There were 255[74.6%] males and 87[25.4%] females. There were 103[30.1%] diabetics, 137[40.1%] hypertensive and 174[50.9%] smokers. Family history of IHD was present in 34[9.9%]. Obesity was observed in 60[17.5%]. Dyslipidemia was observed in 45[13.2%]. Majority of patients 123[36%] presented between 4-8 hours after the onset of symptoms. Only 72[21.1%] patients presented to the hospital within 4 hours of onset of symptoms. Overall 194[56.7%] patients had anterior wall myocardial infarction followed by Inferior wall myocardial infarction 84[24.6%] patients. Streptokinase therapy for thrombolysis was given to 236[69%] patients. Overall in-hospital mortality was 28[8.2%]. Most frequent in-hospital complication was cardiogenic shock occurring in 38[11.1%] followed by lschemic complications [Post Ml angina and Re-MI] 37[10.8%], heart failure in 37[10.8%] and 1[st] and 2[nd] degree AV blocks in 36[10.5%] patients. In-hospital mortality was most significantly associated with site of Ml i.e. anterior wall myocardial infarction [X[2]=28.88, p=0.0001] followed by patients not receiving Streptokinase therapy [X[2]=18, p=0.001], Age [X[2]=10.13, p=0.006]. Site of Ml had the highest Contingency Coefficient value of 0.279 followed by Streptokinase therapy 0.195 and age 0.170. Cardiogenic shock was the most frequent complication. Major predictors of in-hospital mortality were anterior wall myocardial infarction, patients not receiving streptokinase therapy and old age
RESUMO
To analyze the influence of diabetes mellitus on circadian rhythm affecting the onset of acute ST elevation myocardial infarction. Observational study. February to August 2010. Faisalabad Institute of Cardiology, Faisalabad. Three hundred and seven consecutive patients who fulfilled the inclusion and exclusion criteria and presented with first MI were studied. All patients were divided into four groups according to the 6:00 hours interval of the day [Circadian rhythm]. Group I comprised of patients presenting with onset of symptoms between 0-6 hours, Group II 6:01 to 12:00 hours, Group III 12:01 to 18:00 hours and Group IV 18:01 to 24:00 hours. Data was analyzed for variations within groups. Two peaks of onset of symptoms were observed, first between 0-6 hours 144 [33.9%] patients and the second between 6:01 to 12:00 hours 87 [28.3%] and a non significant association was observed in time of onset of acute myocardial infarction P = 0.082. The trough was evening time 12:01 to 18:00 hours where only 63 [20.5%] patients had acute myocardial infarction. Mean age of study population was 56 +/- 12.7 years. Mean age was similar in all the four groups P = 0.155. There were 228 [74.3%] males, 79 [25.5%] females. The circadian morning peak of MI symptom onset was attenuated in patients with diabetes as Group IV consisted of higher number 24 [37.5%] of diabetics followed by group I 23 [34.7%]. Overall group II had the maximum number of hypertensive patients 41 [47.1%] as compared to other groups. Obesity was observed in 55 [18%] with similar number of patients in all groups P = 0.492. Majority of patients 117 [38.1%] presented between 4-8 hours after the onset of symptoms. Overall 170 [55.4%] patients had anterior wall myocardial infarction followed by inferior wall myocardial infarction in 82 [26.7%] patients. Our study demonstrates that the circadian morning peak of MI symptom onset was attenuated in patients with diabetes, suggesting a role of autonomic dysfunction. Inconsistency in observation of such an effect in patients with diabetes in the past may well have been due to differences in the duration of diabetes