Introduction
Materials and methods
Patients and study design
Procedures
Thrombus analysis
Immunohistochemistry
Biochemical assays
Blood glucose control in emergency wards
Follow-up
Outcomes
Statistical analyses
TA group | P | No TA group | P | |||
---|---|---|---|---|---|---|
Basal | Follow-up | Basal | Follow-up | |||
N | 1000 | 1000 | 1504 | 1504 | ||
Mean age (years) | 68.1 ± 6.5 | – | 67.2 ± 6.4* | – | ||
BMI (kg/m2) | 27.0 ± 2.0 | 26.9 ± 1.9 | 0.001 | 27.6 ± 1.8* | 26.9 ± 2.1 | 0.001 |
SBP (mmHg) | 128.0 ± 13.0 | 123.0 ± 11.7 | 0.001 | 127.0 ± 13.1 | 125.0 ± 13.1* | 0.001 |
DBP (mmHg) | 79.0 ± 6.8 | 76.0 ± 6.6 | 0.001 | 79.0 ± 6.7 | 76.2 ± 6.8 | 0.001 |
Heart rate (bpm) | 85.0 ± 8.9 | 76.1 ± 8.6 | 0.001 | 87.0 ± 8.7* | 77.0 ± 8.5* | 0.001 |
TIMI flow grade, n (%) | ||||||
Grade 0 | 705 (70.5) | – | – | 978 (65.0)* | – | – |
Grade 1 | 157 (15.7) | – | – | 218 (14.5) | – | – |
Grade 2/3 | 92 (13.8) | – | – | 309 (20.5)* | – | – |
Killip class 3–4, n (%) | 60 (6) | – | 76 (5) | – | ||
Diabetes, n (%) | 185 (18.5) | – | – | 283 (18.8) | – | – |
Newly diabetes, n (%) | – | 136 (13.6) | – | 228 (15.2) | – | |
Hypertension, n (%) | 503 (50.3) | – | – | 743 (49.4) | – | – |
Hyperlipemia, n (%) | 275 (27.5) | – | – | 443 (29.5) | – | – |
Cigarette smoking, n (%) | 444 (44.4) | – | – | 565 (37.6)* | – | – |
Active treatments | ||||||
β-blockers, n (%) | 296 (26.6) | 824 (82.4) | 0.001 | 392 (26.1)* | 1221 (81.2) | 0.001 |
ACE inhibitors, n (%) | 211 (21.1) | 504 (50.4) | 0.001 | 272 (18.1)* | 734 (48.8) | 0.001 |
Angiotensin receptor blockers, n (%) | 165 (16.5) | 372 (37.2) | 0.001 | 218 (14.5) | 554 (36.8) | 0.001 |
Calcium inhibitor, n (%) | 129 (12.9) | 210 (21.0) | 0.001 | 159 (10.6)* | 300 (19.9) | 0.001 |
Nitrate, n (%) | – | 577 (57.7) | – | – | 916 (60.9) | |
Statins, n (%) | 286 (28.6) | 917 (91.7) | 0.001 | 428 (28.5) | 1381 (91.8) | 0.001 |
Diuretic, n (%) | 96 (9.6) | 92 (9.2) | 0.409 | 175 (11.6) | 111 (7.4) | 0.001 |
Insulin, n (%) | 78 (7.8) | 174 (17.4) | 0.001 | 129 (8.6) | 353 (23.5)* | 0.001 |
Oral anti-diabetic, n (%) | 168 (16.8) | 282 (28.2) | 0.001 | 266 (17.6) | 534 (35.5)* | 0.001 |
Aspirin, n (%) | 432 (43.2) | 973 (97.3) | 0.001 | 601 (40.0) | 1459 (97.0)* | 0.001 |
Thienopyridine, n (%) | 63 (6.3) | 949 (94.9) | 0.001 | 120 (8.0) | 1432 (95.2) | 0.001 |
Dual anti-aggregant therapy | – | 937 (93.7) | – | – | 1399 (93.0) | – |
Low-molecular heparin, n (%) | – | 12 (12.4) | – | – | 190 (12.6) | – |
Vitamin-K antagonist, n (%) | – | 37 (3.7) | – | – | 54 (3.6) | – |
Laboratory analyses | ||||||
Plasma glucose (mg/dl) | 138.3 ± 26.4 | 109.1 ± 22.9 | 0.001 | 141.7 ± 50.1 | 109.6 ± 18.8 | 0.001 |
Cholesterol (mg/dl) | 198.8 ± 20.3 | 194.4 ± 22.8 | 0.001 | 196.2 ± 24.1* | 193.9 ± 23.6 | 0.01 |
LDL-cholesterol (mg/dl) | 125.6 ± 19.6 | 121.2 ± 22.4 | 0.001 | 123.7 ± 22.7* | 120.9 ± 22.2 | 0.001 |
HDL-cholesterol (mg/dl) | 39.7 ± 3.6 | 41.1 ± 3.8 | 0.001 | 38.0 ± 3.7* | 41.0 ± 3.9* | 0.001 |
Triglycerides (mg/dl) | 168.0 ± 24.0 | 160.3 ± 24.7 | 0.001 | 180.6 ± 24.4* | 160.9 ± 22.2 | 0.001 |
Creatinine (mg/dl) | 0.9 ± 0.2 | 1.0 ± 0.1 | 0.001 | 0.9 ± 0.1 | 1.01 ± 0.1 | 0.001 |
cTnT (ng/l) | 5.6 ± 1.4 | – | – | 5.8 ± 1.7 | – | – |
Procedural data | ||||||
Symptom to angiography (min) | 136.9 ± 37.2 | – | – | 135.8 ± 41.1 | – | – |
Insulin infusion time (min) | – | – | – | – | – | – |
Angiographic data | ||||||
Number of diseased vessels, n (%) | ||||||
1-VD | 704 (70.4) | – | – | 1055 (70.1) | – | – |
2-VD | 244 (24.4) | – | – | 356 (23.7) | – | – |
3-VD | 52 (5.2) | – | – | 93 (6.2) | – | – |
Lesion location, n (%) | ||||||
RCA | 512 (51.2) | – | – | 665 (44.2)* | – | – |
LAD | 390 (39.0) | – | – | 581 (38.6) | – | – |
LM | 151 (15.1) | – | – | 196 (13.0) | – | – |
LCx | 298 (29.8) | – | – | 604 (40.2)* | – | – |
Trombus grade—Sianos et al. n (%) | ||||||
G0 none | 94 (9.4) | – | – | 143 (9.5) | – | – |
G1 possible | 86 (12.9) | – | – | 194 (12.9) | – | – |
G2 small | 78 (7.8) | – | – | 124 (8.2) | – | – |
G3 medium | 181 (18.1) | – | – | 275 (18.3) | – | – |
G4 large | 193 (19.3) | – | – | 292 (19.4) | – | – |
G5 v. occlusion | 332 (33.2) | – | – | 476 (31.6) | – | – |
Dimension (largest) (mm) | 5.5 ± 1.6 | – | – | – | – | – |
Dimension (length) (mm) | 22.5 ± 1.9 | – | – | – | – | – |
LVEF, n (%) | ||||||
> 50 | 513 (51.3) | 571 (57.1) | 0.005 | 813 (54.1) | 881 (58.5) | 0.008 |
41–50 | 413 (41.3) | 374 (37.4) | 0.041 | 614 (40.8) | 548 (36.8) | 0.007 |
25–40 | 74 (7.4) | 54 (5.4) | 0.046 | 76 (5.1)* | 75 (5.0) | 0.533 |
Quantitative angiographic data | ||||||
Lesion length (mm) | 20.5 ± 2.0 | – | – | 20.3 ± 2.0* | – | – |
Reference diameter (mm) | 2.7 ± 0.3 | – | – | 2.8 ± 0.2* | – | – |
MLD (mm) | 1.05 ± 0.2 | – | – | 1.07 ± 0.2* | – | – |
MLD post (in-stent) (mm) | 2.6 ± 0.3 | – | – | 2.6 ± 0.3 | – | – |
Stent types, n (%) | ||||||
BMS | 455 (45.5) | – | – | 642 (41.6) | – | – |
DES | 545 (54.5) | – | – | 873 (56.4) | – | – |
TIMI gr 3 post PCI | 920 (92.0) | – | – | 1355 (90.1) | – | – |
TIMI gr 2 post PCI | 54 (5.4) | – | – | 92 (6.1) | – | – |
TIMI gr 1 post PCI | 22 (2.2) | – | – | 47 (3.1) | – | – |
TIMI gr 0 post PCI | 4 (0.4) | – | – | 12 (0.8) | – | – |
Multivessel intervention | 241 (24.1) | – | – | 363 (24.1) | – | – |
Clinical outcomes | ||||||
All cause deaths | – | 56 (5.6) | – | – | 96 (6.4) | – |
Cardiac deaths | – | 48 (4.8) | – | – | 89 (5.9) | – |
Acute coronary syndrome | – | 67 (6.7) | – | – | 107 (7.1) | – |
Heart failure | – | 121 (12.1) | – | – | 186 (12.4) | – |
Stroke | – | 12 (1.2) | – | – | 19 (1.3) | – |
TA group | P | No TA group | P | |||
---|---|---|---|---|---|---|
Basal | Follow-up | Basal | Follow-up | |||
N | 331 | 331 | 566 | 566 | ||
Mean age (years) | 68.5 ± 6.3 | – | 66.8 ± 6.4* | – | ||
BMI (kg/m2) | 27.9 ± 1.7 | 26.7 ± 1.9 | 0.001 | 27.8 ± 1.6 | 26.9 ± 2.1* | 0.001 |
SBP (mmHg) | 123.7 ± 11.2 | 122.1 ± 11.7 | 0.001 | 126.7 ± 12.6* | 126.1 ± 13.5* | 0.077 |
DBP (mmHg) | 79.1 ± 6.5 | 76.6 ± 6.6 | 0.001 | 78.8 ± 6.7 | 75.9 ± 6.7 | 0.001 |
Heart rate (bpm) | 87.1 ± 8.0 | 77.1 ± 9.3 | 0.001 | 87.8 ± 8.4 | 76.7 ± 8.5 | 0.001 |
TIMI flow grade post PCI, n (%) | ||||||
Grade 0 | 13 (3.9) | – | 43 (7.6)* | – | ||
Grade 1 | 81 (24.5) | – | 191 (33.7)* | – | ||
Grade 2/3 | 237 (71.6) | – | 332 (58.6)* | – | ||
Killip class 3–4, n (%) | 24 (7) | – | 34 (6) | – | ||
Diabetes, n (%) | 67 (20.2) | – | 116 (20.5) | – | ||
Newly diabetes, n (%) | – | 32 (9.7) | – | – | 50 (8.8) | |
Hypertension, n (%) | 129 (38.9) | – | 220 (38.9) | – | ||
Hyperlipemia, n (%) | 93 (28.1) | – | 115 (27.4) | – | ||
Cigarette smoking, n (%) | 132 (39.9) | – | 178 (31.5)* | – | ||
Active treatments | ||||||
β-blockers, n (%) | 91 (27.5) | 260 (78.5) | 0.001 | 155 (27.4) | 442 (78.1) | 0.001 |
ACE inhibitors, n (%) | 59 (17.8) | 140 (45.0) | 0.001 | 105 (18.5) | 257 (45.4) | 0.001 |
Angiotensin receptor blockers, n (%) | 45 (13.6) | 114 (34.4) | 0.001 | 83 (14.7) | 201 (35.5) | 0.001 |
Calcium inhibitor, n (%) | 29 (8.8) | 63 (19.0) | 0.001 | 56 (9.9) | 109 (19.3) | 0.001 |
Nitrate, n (%) | – | 195 (58.9) | – | 320 (56.5) | ||
Statins, n (%) | 83 (25.1) | 308 (93.0) | 0.001 | 143 (25.3) | 526 (92.9) | 0.001 |
Diuretic, n (%) | 29 (8.8) | 32 (9.7) | 0.05 | 48 (8.5) | 43 (7.6) | |
Insulin, n (%) | 35 (10.6) | 48 (14.5) | 0.01 | 60 (10.6) | 65 (11.5) | 0.05 |
Oral antidiabetic, n (%) | 59 (17.8) | 89 (26.9) | 0.001 | 101 (17.8) | 132 (23.3) | 0.01 |
Aspirin, n (%) | 146 (44.1) | 327 (98.6) | 0.001 | 251 (44.3) | 557 (98.5) | 0.001 |
Thienopyridine, n (%) | 27 (8.2) | 318 (96.1) | 0.001 | 46 (8.1) | 538 (95.0) | 0.001 |
Dual anti-aggregant therapy | – | 313 (94.6) | – | – | 427 (93.1) | – |
Low-molecular heparin, n (%) | – | 41 (12.4) | – | 76 (13.4) | – | |
Vitamin-K antagonist, n (%) | – | 17 (5.1) | – | 28 (4.9) | – | |
Laboratory analyses | ||||||
Plasma glucose (mg/dl) | 201.4 ± 25.1 | 109.1 ± 23.5 | 0.001 | 200.1 ± 29.9 | 106.1 ± 22.5 | 0.001 |
Cholesterol (mg/dl) | 201.9 ± 21.8 | 195.6 ± 22.1 | 0.001 | 198.1 ± 21.9* | 194.7 ± 22.7 | 0.001 |
LDL-cholesterol (mg/dl) | 128.3 ± 21.4 | 122.4 ± 22.1 | 0.001 | 124.3 ± 18.6* | 121.7 ± 22.3 | 0.001 |
HDL-cholesterol (mg/dl) | 37.3 ± 3.4 | 41.2 ± 3.6 | 0.001 | 38.0 ± 3.5* | 40.7 ± 3.9 | 0.001 |
Triglycerides (mg/dl) | 185.3 ± 23.5 | 160.1 ± 31.9 | 0.001 | 185.7 ± 22.5 | 161.5 ± 22.7 | 0.001 |
Creatinine (mg/dl) | 0.99 ± 0.15 | 1.04 ± 0.13 | 0.001 | 0.99 ± 0.14 | 1.4 ± 0.14 | 0.001 |
cTnT (ng/l) | 5.7 ± 2.1 | – | – | 5.9 ± 1.8 | – | – |
Procedural data | ||||||
Symptom to angiography (min) | 133.8 ± 38.9 | – | – | 135.1 ± 50.7 | – | – |
Insulin infusion time (min) | 37.7 ± 5.2 | – | – | 37.3 ± 4.4 | – | – |
Angiographic data | ||||||
Number of diseased vessels, n (%) | ||||||
1-VD | 228 (68.9) | – | – | 388 (68.5) | – | – |
2-VD | 86 (26.0) | – | – | 143 (25.3) | – | – |
3-VD | 17 (5.1) | – | – | 35 (6.2) | – | – |
Lesion location, n (%) | ||||||
RCA | 185 (55.9) | – | – | 257 (45.4)* | – | – |
LAD | 118 (36.5) | – | – | 228 (40.3) | – | – |
LM | 45 (13.6) | – | – | 79 (13.9) | – | – |
LCx | 103 (31.1) | – | – | 215 (39.9)* | – | – |
Thrombus grade—Sianos et al., n (%) | ||||||
G0 none | 30 (9.1) | – | – | 62 (10.9) | – | – |
G1 possible | 38 (11.5) | – | – | 70 (12.4) | – | – |
G2 small | 16 (4.8) | – | – | 35 (6.2) | – | – |
G3 medium | 57 (17.2) | – | – | 99 (17.5) | – | – |
G4 large | 62 (18.7) | – | – | 108 (19.1) | – | – |
G5 v. occlusion | 128 (38.7) | – | – | 192 (33.9) | – | – |
Thrombus size (mm) | 34 ± 1.9 | – | – | – | – | – |
LVEF, n (%) | ||||||
> 50 | 165 (49.9) | 198 (59.8) | 0.006 | 288 (50.9) | 331 (58.5) | 0.006 |
41–50 | 151 (45.6) | 116 (35.0) | 0.004 | 249 (44.0) | 208 (36.7) | 0.01 |
25–40 | 15 (4.5) | 17 (5.1) | 0.428 | 29 (5.1) | 27 (4.8) | 0.139 |
Quantitative angiographic data | ||||||
Lesion length (mm) | 20.3 ± 2.0 | – | – | 20.2 ± 2.1 | – | – |
Reference diameter (mm) | 2.7 ± 0.4 | – | – | 2.8 ± 0.3 | – | – |
MLD (Mm) | 1.05 ± 0.29 | – | – | 1.07 ± 0.16 | – | – |
MLD post (in-stent) (mm) | 2.7 ± 0.3 | – | – | 2.7 ± 0.2 | – | – |
Stent types, n (%) | ||||||
BMS | 146 (44.1) | – | – | 233 (41.2) | – | – |
DES | 185 (55.9) | – | – | 333 (58.8) | – | – |
TIMI gr 3 post PCI | 285 (86.1) | – | – | 498 (87.9) | – | – |
Multivessel intervention | 79 (23.9) | – | – | 134 (23.7) | – | – |
Clinical outcomes | ||||||
All cause deaths | – | 27 (8.2) | – | 74 (13.1) | – | |
Cardiac deaths | – | 17 (5.1) | – | 62 (10.9) | – | |
Acute coronary syndrome | – | 25 (7.5) | – | 67 (11.8) | – | |
Heart failure | – | 53 (16.1) | – | 93 (16.4) | – | |
Stroke | – | 6 (1.8) | – | 11 (1.9) | – |
Results
Patient characteristics
In-hospital treatments and glucose control
Treatments at 12 months following discharge
In-hospital and post-discharge outcomes
Coronary thrombus analysis in hyperglycemic and normo-glycemic patients
Characteristics of the thrombus | Hyperglycemic patients | Normo-glycemic patients | P |
---|---|---|---|
Dimension (largest) (mm) | 8.9 ± 2.7 | 2.2 ± 1.2* | 0.001 |
Dimension (length) (mm) | 34 ± 2.9 | 11 ± 0.8 | |
Fibrin (%) | 38.6 ± 11.1 | 62.4 ± 15.6* | 0.001 |
Platelet (%) | 11.3 ± 6.2 | 12.5 ± 3.2 | 0.001 |
CD68 (%) | 24.7 ± 4.9 | 9.1 ± 3.2* | 0.001 |
TNF-α (pg/mg) | 44.7 ± 12.1 | 19.3 ± 10.5* | 0.001 |
MMP-9 (µg/mg) | 16.9 ± 4.4 | 6.2 ± 1.6* | 0.001 |
Nitrotyrosine (nmol/pg) | 2.5 ± 0.21 | 1.1 ± 0.24 | 0.001 |