Complications and mortality in ST-segment elevation acute myocardial infarction in diabetic and non-diabetic patients

ABSTRACT

The difference in environmental conditions along with foods in the subcontinent than other parts of the world incited this work to see how complications and outcome differ in diabetic and non-diabetic patients. 240 patients [76 diabetic and 164 non-diabetic] suffering from ST-segment Elevation acute myocardia infarction were included in the study. Complications of Acute Myocardial Infarction [AMI] and the outcome were compared between diabetics and non-diabetic patients. Different complications studied varied significantly [P<0.001] within diabetics, non-diabetics and in overall after controlling for diabetes. Complications showed similar pattern [heterogeneity test P>0.5] in diabetic and non-diabetic patients. The abnormalities including Cardiogenic shock [OR = 1.9; 95% CI=0.85-4.22], left ventricular failure [OR = 2.5], re-infarction [OR=2.2], arrhythmia [OR=2.04] and ventricular septal defect [OR=2.17] were 4.2, 21.3, 4.2 and 85.24 times higher in diabetics, respectively. However, occurrence of post myocardial angina [OR=0.38] was low in diabetics than non-diabetics. Odds of having diastolic dysfunction were 1.8 times higher in diabetic patients. The moderate and severe LV-dysfunction was 3.3 and 2.5 times higher diabetics, while mild LV-dysfunction in was 2.1 times higher in non-diabetics. Mortality due to STEMI in diabetics was 2.3 times higher than in non-diabetics. Mortality varied significantly between different age groups in non-diabetics and in overall after controlling for diabetes. In non-diabetic group, mortality was 8.4 times higher in patients those were not given streptokinase than those were given streptokinase, while in diabetic group it was 2.5 times higher in patients were not given streptokinase than those were given streptokinase. The results indicate that the diabetics have higher risk of mortality. Inferior infarction is more serious in diabetics than non-diabetics and chances of survival in streptokinase treated patients is five times in non-diabetic while it about two times in diabetics. The results suggest the importance of streptokinase treatment in patients having ST-segment Elevation Acute Myocardial Infarction