GW26-e4737 Prognosis of Diabetic patients with non ST-elevation Myocardial Infarction

INTRODUCTION Implantation of bare metal or drug eluting stents supported by dual antiplatelet therapy (DAPT) is standard treatment for the management of patients with ST elevation myocardial infarction (STEMI). Individual response to aspirin and clopidogrel is heterogeneous, and decreased response is associated with thrombotic events following stenting. We postulated that systemic inflammation at the time of STEMI would diminish responsiveness to DAPT. The aim of this study is to evaluate the correlation between elevated high-sensitivity C-reactive protein (hs-CRP) as a marker of inflammation and decreased platelet sensitivity to DAPT in STEMI. METHODS We recruited patients with STEMI undergoing percutaneous coronary intervention (PCI) who received oral clopidogrel 600 mg loading dose followed by 75 mg daily maintenance dose and aspirin 325 mg daily. Platelet reactivity and hs-CRP were measured within 72 hours of PCI and at 6 weeks. For patients receiving eptifibatide, blood samples were taken 48 hours after discontinuation. Platelet reactivity was assessed using the VerifyNow platelet function analyzer. A cut-off value of 208 platelet reaction units (PRU) was used to define high on-clopidogrel platelet reactivity (HCPR) and a value of 454 aspirin reaction units (ARU) was used to define high on-aspirin platelet reactivity (HAPR). RESULTS In 20 patients aged 31 to 85, in hospital and 6 weeks after STEMI, hs-CRP was 6.7 (SD 4.0) and 2.6 (SD 3.2) respectively, p< 0.01. Changes in ARU from 408.3 (SD 54.3) to 425.2 (SD 68.2) and PRU from 157.8 (SD 74.7) to 164.2 (SD 75) were not statistically significant. 2 patients had HAPR in hospital; 1 became sensitive at follow up. 2 patients developed HAPR and HCPR. We saw a trend towards higher PRU in diabetic patients and those prescribed statins. CONCLUSIONS Although we found a significant difference in hs-CRP levels between the first and second time point, no significant difference was found in on-aspirin and on-clopidogrel platelet reactivity between the time points.Thus, in this small series, the acute inflammatory state associated with STEMI did not appear to influence the on-DAPT reactivity at the dosages used. Trends among those with diabetics and prescribed statins will be discussed

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THROMBOLYTIC EFFICACY OF STREPTOKINASE IN ELDERLY TYPE 2 DIABETES MELLITUS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION USING ELECTROCARDIOGRAPHIC ST-SEGMENT RESOLUTION

10.36106/ijsr/2102452 ◽

2021 ◽

pp. 67-70

Author(s):

Mahendra Pratap ◽

Somil Verma ◽

S. L. Mathur

Keyword(s):

Myocardial Infarction ◽

Elderly Patients ◽

Thrombolytic Therapy ◽

Care Center ◽

Tertiary Care ◽

St Elevation Myocardial Infarction ◽

Diabetic Patients ◽

Common Location ◽

St Segment ◽

St Elevation

Background: Age and diabetes are important prognostic factors in patients with acute ST-elevation myocardial infarction (STEMI) undergoing thrombolysis. In our study we compared the post-thrombolytic effect of streptokinase in elderly diabetic and non-diabetic patients. Methods: A prospective observational study was conducted in tertiary care center of India in which 140 elderly patients diagnosed with STEMI and undergoing thrombolytic therapy with streptokinase were enrolled after making necessary exclusions and were divided into diabetic (n=70) and non-diabetic (n=70) as study and control groups respectively. ECG was done immediately before and at 60 minutes after thrombolytic therapy. ST-segment resolution was measured and patients were classied as failed (<30%), partial (30-70%) and successful (>70%) resolution of STsegment. Results: Failed thrombolysis was evident in 34.3% non-diabetic and 57.1% diabetic patients (p=0.010). The incidence of successful thrombolysis was present in 41.4% non-diabetic and 28.6% diabetic patients, whereas partial thrombolysis was seen in 24.3% non-diabetic and 14.3% diabetics. Anterior wall was the most common location of infarction in elderly population but the proportion was higher in diabetics than non-diabetics (p=0.025). Conclusion: Failed thrombolysis with streptokinase was higher in diabetics than in non-diabetics after 60 minutes of streptokinase infusion in elderly patients warranting the need of using another cost effective and easily available agent for elderly diabetic population.

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Glycoprotein IIb/IIIa Receptor Blockade Improves Outcomes in Diabetic Patients Presenting With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Circulation ◽

10.1161/01.cir.102.20.2466 ◽

2000 ◽

Vol 102 (20) ◽

pp. 2466-2472 ◽

Cited By ~ 54

Author(s):

Pierre Théroux ◽

Joe Alexander ◽

Chantal Pharand ◽

Eliav Barr ◽

Steven Snapinn ◽

...

Keyword(s):

Myocardial Infarction ◽

Unstable Angina ◽

St Elevation Myocardial Infarction ◽

Diabetic Patients ◽

Receptor Blockade ◽

St Elevation

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P1642The impact of residual non-culprit stenoses in diabetic and non-diabetic patients with ST elevation myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehy565.p1642 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

S N Burgess ◽

C P Juergens ◽

T L Nguyen ◽

M Leung ◽

D A B Richards ◽

...

Keyword(s):

Myocardial Infarction ◽

St Elevation Myocardial Infarction ◽

Diabetic Patients ◽

St Elevation

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Incidence, predictors and outcomes of stress hyperglycemia in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention

Diabetes and Vascular Disease Research ◽

10.1177/1479164119883983 ◽

2019 ◽

Vol 17 (1) ◽

pp. 147916411988398 ◽

Cited By ~ 1

Author(s):

Mohamed Khalfallah ◽

Randa Abdelmageed ◽

Ehab Elgendy ◽

Yasser Mostafa Hafez

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Primary Percutaneous Coronary Intervention ◽

Odds Ratio ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Diabetic Patients ◽

Stress Hyperglycemia ◽

Percutaneous Coronary ◽

St Elevation

Background: Stress hyperglycemia is a common finding during ST elevation myocardial infarction in diabetic patients and is associated with a worse outcome. However, there are limited data about stress hyperglycemia in non-diabetic patients and its outcome especially in patients undergoing primary percutaneous coronary intervention. Methods: The study was conducted on 660 patients with ST elevation myocardial infarction who were managed with primary percutaneous coronary intervention. Patients were classified into two groups according to the presence of stress hyperglycemia: group I (patients with stress hyperglycemia) and group II (patients without stress hyperglycemia). Patients were analysed for clinical outcome including mortality and the occurrence of major adverse cardiac events. Results: Incidence of stress hyperglycemia was 16.8%, multivariate regression analysis identified the independent predictors of stress hyperglycemia, that were family history of diabetes mellitus odds ratio 1.697 (95% confidence interval: 1.077–2.674, p = 0.023), body mass index >24 kg/m2 odds ratio 1.906 (95% confidence interval: 1.244–2.922, p = 0.003) and cardiogenic shock on admission odds ratio 2.517 (95% confidence interval: 1.162–5.451, p = 0.019). Mortality, cardiogenic shock, contrast induced nephropathy and no reflow phenomenon were significantly higher in stress hyperglycemia group with p value = 0.027, 0.001, 0.020 and 0.037, respectively. Conclusion: Stress hyperglycemia in non-diabetic patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with increased incidence of no reflow phenomenon, contrast induced nephropathy, cardiogenic shock and higher mortality.

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