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 classied 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.
Prehospital thrombolytic therapy for ST-elevation myocardial infarction: Reply
