Diabetes and acute stress hyperglycemia differently influence coronary thrombus composition in STEMI patients after primary PCI.

Background: Acute coronary thrombosis is the critical event for STEMI. The local inflammatory microenvironment (cellular effectors and soluble mediators) influences thrombus formation and evolution. We aimed to evaluate the influence of diabetes and acute hyperglycemia on coronary thrombus composition in STEMI patients. Methods: We studied 49 STEMI patients undergoing primary PCI (Male 75%, mean age 66±13 SD, diabetes 20%). Intracoronary thrombus composition analysis was based on the presence of fresh material (inflammatory cells, platelet aggregates and fibrin) vs. organized material (connective tissue, smooth muscle cells), as well as on the level of CD3+ T-cell infiltration (immunohistochemistry). Hyperglycemia was defined as an admission plasma glucose level of >=126 mg/dl. Routinely laboratory data concerning differential and total leukocyte and platelet count, glycemia, CRP and fibrinogen, were collected in peripheral blood samples at the admission. Results: Diabetes was significantly associated with a higher CD3+T-cell thrombus infiltration (>=150 cells/mm2) (p=0.0231), while acute hyperglycemia was mainly associated with a fresh thrombus composition (p=0.0114). Acute hyperglycemia was associated with higher levels of CRP (p=0.0563), fibrinogen (p=0.0792), neutrophil/lymphocyte ratio (p=0.0086) and platelet/lymphocyte ratio (p=0.0042); no association in diabetic patients. Conclusions: In STEMI, acute hyperglycemia seems to influence the innate immune-mediated inflammatory response in thrombus composition, while diabetes seems to be mainly involved in thrombus recruitment of adaptive immune cellular effectors.