Acute systemic cellular inflammatory response, but not coronary thrombus composition, is associated with impairment of reperfusion in STEMI patients after primary PCI.

Background: No-reflow phenomenon is associated with adverse clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PCI). We investigated the association between angiographic reperfusion with hystopathological features of aspirated intracoronary thrombus as well as with peripheral inflammatory and metabolic response at admission. Methods: Among 119 consecutive STEMI patients undergoing primary PCI (male 76%, mean age 65±13 SD), 49 thrombi were suitable for hystopathological analysis. Basically, thrombus composition analysis was based on material organization (cell type, connective tissue and fibrin deposition) and presence of atheroma fragments. Routinely laboratory data concerning differential and total leukocyte and platelet count, glycemia, lipoproteins (HDL, LDL), GGT, CRP and fibrinogen, were collected in peripheral blood samples at t admission. No reflow was defined as TIMI flow < 3 at the end of primary PCI. Results: Hystopathological features of coronary thrombi did not differ according to TIMI grade score nor between patients with TIMI < 3 or =3. Conversely, a higher number of circulating neutrophils (p=0.0069) and total leukocytes (p= 0.06) were found in patients with no reflow (TIMI < 3). Notably, neutrophils number directly correlated with acute glicemia levels (p=0.0004), but not with the presence of diabetes. Conclusions: Our data support the hypothesis that impaired myocardial reperfusion after primary PCI is not influenced by thrombus composition. Conversely, the extent of systemic acute inflammatory response as well as hyperglycemia might play a role, or be a marker, of no-reflow phenomenon in STEMI.