Post-Thrombolysis Immediate Clinical Outcome in Diabetic vs Non-Diabetic STEMI Patients at FGPC Cardiology Unit Islamabad

Abstract

Background: Diabetes mellitus is a major independent risk factor for cardiovascular disease and is associated with increased morbidity and mortality following acute ST-elevation myocardial infarction (STEMI). Despite the proven efficacy of thrombolytic therapy, diabetic patients often exhibit impaired reperfusion outcomes and greater complication rates due to underlying microvascular dysfunction and delayed myocardial recovery. Evaluating post-thrombolytic outcomes in diabetic versus non-diabetic patients provides valuable insight into disease-specific prognostic differences. Objective: To compare the efficacy of thrombolysis with streptokinase in diabetic and non-diabetic patients presenting with STEMI using electrocardiographic (ECG) parameters and to assess the incidence of short-term in-hospital complications within 24 hours post-thrombolysis. Methods: This prospective cohort study was conducted in the Department of Cardiology, Federal Government Polyclinic Hospital, Islamabad, from January to May 2025. A total of 115 patients diagnosed with STEMI were included, comprising 48 (41.7%) diabetics and 67 (58.3%) non-diabetics. All patients received streptokinase within 12 hours of symptom onset. ST-segment resolution was evaluated 90 minutes post-thrombolysis, categorized as >70%, 30–70%, or <30%. Clinical outcomes, including resolution of chest pain, arrhythmia, heart failure, cardiogenic shock, and need for rescue PCI, were observed for 24 hours. Statistical analysis was performed using SPSS version 23, with a p-value <0.05 considered significant. Results: Complete chest pain resolution occurred in 37.5% of diabetics and 56.2% of non-diabetics (p=0.023). ST-segment resolution >70% was observed in 31.3% of diabetics versus 46.3% of non-diabetics (p=0.093). Heart failure developed in 60.4% of diabetics and 31.3% of non-diabetics (p=0.006), while cardiogenic shock occurred in 22.9% and 4.4%, respectively. Arrhythmias were noted in 10.4% of diabetics and 5.9% of non-diabetics. One non-diabetic patient died within 24 hours post-thrombolysis. Conclusion: Diabetic patients demonstrated poorer immediate outcomes after thrombolysis, with reduced ST-segment and symptom resolution and a higher incidence of early complications. Diabetes adversely affects reperfusion efficacy and short-term prognosis, emphasizing the need for early recognition and individualized management in this high-risk group