title: The role of diabetes mellitus in the composition of coronary thrombi in patients presenting with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  Although diabetes mellitus (DM) is a predictor of poor outcomes in patients with ST-segment elevation myocardial infarction (STEMI), few studies have analyzed the impact of DM on the constituency of coronary thrombi.
  
  
  OBJECTIVE
  Comparing morphologic and histopathologic aspects of coronary thrombi in STEMI patients with and without DM who underwent primary percutaneous coronary intervention.
  
  
  METHODS
  All consecutive patients with STEMI admitted to our institution between April 2010 and December 2012 (n = 1,548) were considered for inclusion. Thrombus material was obtained by aspiration thrombectomy; morphologic and histopathologic aspects were assessed by 3 independent pathologists blinded to clinical characteristics and outcomes. Patients with DM were compared with those without DM. A sensitivity analysis was performed using a propensity score.
  
  
  RESULTS
  During the study period, coronary thrombi material from 259 patients was obtained, of whom 19% (n = 49) had diabetes. Diabetic patients were older (P = .10), had a higher frequency of hypertension (P < .01) and dyslipidemia (P = .03), and had a trend to a longer time from the onset of chest pain to hospital arrival (P = .08). The number of retrieved fragments, the size of the thrombi and its composition (leukocytes, fibrin, and erythrocytes percent), and thrombus age and color were similar between patients with or without DM. There were also no statistically significant differences in thrombus constituency of the propensity score-matched patients (n = 92).
  
  
  CONCLUSIONS
  In this study, morphologic and histopathologic constituency of coronary thrombi in the setting of a ST-elevation myocardial infarction was not significantly different between patients with or without DM. This finding was intriguing and deserves further investigation.
authors: Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
authors: Juliana C
authors: JC
authors: Sebben
authors: Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
authors: Daniel R
authors: DR
authors: Pinto Ribeiro
authors: Duke Clinical Research Institute, Durham, NC; Federal University of São Paulo (USP), São Paulo, Brazil; Brazilian Clinical Research Institute, São Paulo, Brazil.
authors: Renato D
authors: RD
authors: Lopes
authors: University of Amsterdam, Amsterdam, the Netherlands.
authors: Robert
authors: R
authors: de Winter
authors: Duke Clinical Research Institute, Durham, NC.
authors: Ralf
authors: R
authors: Harskamp
authors: Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
authors: Eduardo
authors: E
authors: Cambruzzi
authors: Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
authors: Marcia Moura
authors: MM
authors: Schmidt
authors: Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
authors: Eduarda Schutz
authors: ES
authors: Martinelli
authors: Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil.
authors: Carlos A
authors: CA
authors: Gottschall
authors: Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, Brazil. Electronic address: alesq@terra.com.br.
authors: Alexandre S
authors: AS
authors: Quadros
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003328:Coronary Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000209:etiology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D017131:Thrombectomy