DOI: https://doi.org/10.53350/pjmhs211571767 ORIGINAL ARTICLE P J M H S Vol. 15, NO. 7, JUL 2021 1767 ST-Segment Resolution on ECG after Streptokinase with Stemi in Diabetics SAIRA FAYYAZ 1 , AZHER MEHMOOD KIANI, 2 QAZI ABDUL SABOOR 3 , HUSNAIN BASHIR 4 , RAKESH BAHADUR ADHIKARI 5 , TALHA MAHMUD 6 , ABUBAKER HILAL 7 , WASEEM IBRAHIM 8 1 Consultant Cardiologist, City Care Hospital, Khanewal 2 Executive Director & Consultant Cardiologist, Medikay Cardiac Center, Islamabad 3 Professor & Head Department of Cardiology, Shaikh Zayed Medical Complex, Lahore. 4 Registrar, Department of Cardiology, Shaikh Zayed Medical Complex, Lahore. 5 Clinical & Interventional Cardiologist, Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal 6 Profession & Head of Pulmonology Deptt. Sheikh Zayed Hospital, Lahore 7 Senior Registrar, Shaikh Zayed Medical Complex, Lahore. 8 Registrar, Department of Cardiology, Shaikh Zayed Medical Complex, Lahore. Correspondence to: Saira Fayyaz, Email: sairafz86@gmail.com, Cell: 03336396983 ABSTRACT Objective: observe effectiveness of streptokinase in diabetic cases presenting with ST-segment elevation myocardial infarction Methodology: In this descriptive case series we enrolled 200 cases fulfilling inclusion/exclusion criteria from the emergency department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi. The inj. Streptokinase 1.5 million units diluted in 100 ml of normal saline administered over 1 hour and efficacy was observed. Results: Of 200 diabetic STEMI cases, the effectiveness in terms of ST segment resolution by streptokinase in diabetics presenting with ST-segment elevation myocardial infarction (STEMI) was recorded as 38.5%(n=77). Conclusion: The frequency of effectiveness of streptokinase in diabetic cases for resolution of STEMI is encouraging and it can be used as first line therapy. Keywords: STEMI, Diabetics, Streptokinase, efficacy INTRODUCTION Coronary artery disease is leading cause of death in world. With age, risk of Myocardial infarction increases progressively. 1 In Pakistan, among ACS (acute coronary syndrome) patients ,fraction of STEMI (ST-elevation myocardial infarction) is 71.1% while non-STEMI in 8.9%. 2 STEMI is described as new elevation of ST segment at J point of 2mm(0.2mV) or more for men and 1.5mm(0.15mV) or more in women in contiguous leads or 1 mm (0.1 mV) or more in other contiguous limb 3 STEMI is one of most expensive and high risk health problem not only in developed but developing countries as well. 4 Major advances in CVD, particularly ACS treatment had a higher impact on morbidity and mortality in AMI. However, despite these advances, diabetes remains the main risk factor of MI. 5 It has been shown that in STEMI cases, impaired reperfusion may cause a higher mortality rate. 6 Thrombolytic agents i.e., streptokinase are the most popular and using agents for the management of acute MI with the availability in most of the countries of the world. Approximately 400,000- 500,000 patients receiving thrombolytic therapy annually worldwide. 7 In a previous local study ST resolution in Diabetic Patients with ST-Elevation Myocardial Infarction was recorded in 49.1% of the cases. 8 Another local study recorded these findings in 13.8%, 9 another local study by Ahmad Hassan conducted at Jinnah Hospital Lahore recorded these findings in 30% 10 of the cases. Significant variation and Discrepancy was observed in datafor the frequency of ST resolution in diabetic patients with STEMI which makes confusion regarding the use of streptokinase. METHODOLOGY We enrolled a total of 200 diagnosed cases of ST elevation myocardial infarction(within 12 hours of chest pain) diagnosed DM at least 1 year ago with age >40yrs of either gender whereas all patients with previous history of myocardial infarction, already under treatment of streptokinase, having previous history of vasculitisor any other contraindications of streptokinase were excluded. Streptokinase was administered with dose of 1.5million units, diluted in 100 mililiter of normal saline, over 1 hour. Efficacy of streptokinase was recorded. SPSS-19 was sued to analyze the data. RESULTS Age distribution shows that 58%(n=116) were in range of 41 to 60 yrs while 42%(n=84) were between range of 61 to 80 yrs of age, 44.5%(n=89) were male subjects while 55.5%(n=111) were females.Effectiveness of streptokinase in diabetic cases presenting with (STEMI) was recorded as 38.5%(n=77) while 61.5%(n=123) were not treated effectively. (Table No. 1) Table 1: Effectiveness of Streptokinase in Diabetic Cases Presenting with St-Segment Elevation Myocardial Infarction (STEMI) (n=200) Effectiveness No. of patients(%) Age(in years) Gender Duration of DM (yrs) Duration of STEMI (hrs) 41-60 61-80 Male Female 1-3 >3 1-6 7-12 Yes 77(38.55%) 47 30 30 47 41 36 39 38 No 123(61.5%) 69 54 59 64 32 91 27 96 P value 0.49 0.21 0.18 <0.005