Abstract
Objective: To determine the frequency of heart failure after thrombolysis in STEMI patients with diabetes mellitus.
 Methodology: Through a prospective study we have enrolled all the diabetic patients who presented with acute ST-Segment Elevation Myocardial Infarction (STEMI) having age more than 35 years and less than 70 years who underwent pharmacological revascularization both males and females were included in this study. Patients with previous history of revascularization, end stage kidney, liver or heart disease, known advanced valvular heart disease, pregnant women, and those who develop serious complication related to streptokinase were excluded from our study. Echocardiography was done immediately after thrombolysis then after 3 days and then before discharge of the patients to determine the frequency of heart failure. Baseline and clinical data were entered and analysed using SPSS and a chi square test and p-value ≤0.05 was considered as significant.
 Results: A total of 175 patients were finally analysed and most of them were males as compared to females, 63.42% (N = 111) vs. 36.57% (N = 64), respectively. Mean age and SD of the patients was 55.90±10.49 years and mean duration of DM was 12.95±8.40 years. The overall frequency of heart failure in patients with post-STEMI was 56% (N = 98) and their mean ejection fraction was 38.46±8.20%. Frequency of heart failure in diabetic post-STEMI thrombolysed patients was significantly observed higher with increased age, increased duration of diabetes mellitus, hypertension, and smoking (p≤0.05).
 Conclusion: High prevalence of heart failure was observed in diabetic patients admitted with acute STEMI and underwent thrombolysis. The burden is even higher in males having age more than 55 years.
Highlights
ST-Segment Elevation Myocardial Infarction (STEMI) is one of the most common causes of hospitalization in cardiology emergency and is related to high rates of mortality even in the presence of advanced facilities
In Pakistan there is lack of epidemiological data in respect to acute myocardial infarction but data from USA has shown approximately 1.5 million people suffered from acute myocardial infarction in a year and the proportion STEMI is on constant rise [1]
The EF between 20%30% was observed in 20.6% patients, EF between 31%-40% was observed in 36.0% patients, and EF between 41%-50% was observed in 43.4% patients
Summary
ST-Segment Elevation Myocardial Infarction (STEMI) is one of the most common causes of hospitalization in cardiology emergency and is related to high rates of mortality even in the presence of advanced facilities. In Pakistan there is lack of epidemiological data in respect to acute myocardial infarction but data from USA has shown approximately 1.5 million people suffered from acute myocardial infarction in a year and the proportion STEMI is on constant rise [1]. Association of T2DM and occurrence of myocardial infarction is well established. Patients with T2DM are more susceptible to developed acute STEMI and associated complications as compared to without T2DM [3]. The findings from the French registry of Acute ST elevation or non-ST-elevation Myocardial Infarction (FAST-MI) have named it a deadly combination and have shown more than triple the rates of mortality among diabetics and compared to non-diabetics (25.5% vs 10.4%) from heart failure following acute MI [5]
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