Microbiota thrombus colonization may influence athero-thrombosis in hyperglycemic patients with ST segment elevation myocardialinfarction (STEMI). Marianella study.

Aged Cohort Studies Coronary Thrombosis / complications Female Humans Hyperglycemia / complications Male Microbiota / physiology Middle Aged Percutaneous Coronary Intervention / methods Prospective Studies ST Elevation Myocardial Infarction / blood Thrombosis / microbiology Treatment Outcome

Hyperglycemia Microbiota Primary percutaneous coronary intervention STEMI TMAO Thrombus

Journal

Diabetes research and clinical practice

ISSN: 1872-8227

Titre abrégé: Diabetes Res Clin Pract

Pays: Ireland

ID NLM: 8508335

Informations de publication

Date de publication:
Mar 2021

Historique:

received: 26 11 2020

revised: 30 12 2020

accepted: 08 01 2021

pubmed: 17 1 2021

medline: 24 4 2021

entrez: 16 1 2021

Statut: ppublish

Résumé

We examined the association of the coronary thrombus microbiota and relative metabolites with major adverse cardiovascular events (MACE) in hyperglycemic patients with ST segment elevation myocardial infarction (STEMI). Hyperglycemia during STEMI may affect both development and progression of coronary thrombus via gut and thrombus microbiota modifications. We undertook an observational cohort study of 146 first STEMI patients treated with primary percutaneous coronary intervention (PPCI) and thrombus-aspiration (TA). Patients were clustered, based on admission blood glucose levels, in hyperglycemic (≥140 mg/dl) and normoglycemic (<140 mg/dl). We analyzed gut and thrombus microbiota in all patients. Moreover, we assessed TMAO, CD40L and von Willebrand Factor (vWF) in coronary thrombi. Cox regressions were used for the association between Prevotellaspp. and TMAO terziles and MACE. MACE endpoint at 1 year included death, re-infarction, unstable angina. In fecal and thrombus samples, we observed a significantly different prevalence of both Prevotellaspp. and Alistipesspp. between patients with hyperglycemia (n = 56) and those with normal glucose levels (n = 90). The abundance of Prevotella increased in hyperglycemic vs normoglycemic patients whereas the contrary was observed for Alistipes. Interestingly, in coronary thrombus, the content of Prevotella was associated with admission blood glucose levels (p < 0.01), thrombus dimensions (p < 0.01), TMAO, CDL40 (p < 0.01) and vWF (p < 0.01) coronary thrombus contents. Multivariate Cox-analysis disclosed a reduced survival in patients with high levels of Prevotella and TMAO in coronary thrombus as compared to patients with low levels of Prevotella and TMAO, after 1-year follow up. Hyperglycemia during STEMI may increase coronary thrombus burden via gut and thrombus microbiota dysbiosis characterized by an increase of Prevotella and TMAO content in thrombi. NCT03439592. September 30, 2016. Ethic Committee Vanvitelli University: 268/2016.

Sections du résumé

OBJECTIVES OBJECTIVE

BACKGROUND BACKGROUND

Hyperglycemia during STEMI may affect both development and progression of coronary thrombus via gut and thrombus microbiota modifications.

METHODS METHODS

We undertook an observational cohort study of 146 first STEMI patients treated with primary percutaneous coronary intervention (PPCI) and thrombus-aspiration (TA). Patients were clustered, based on admission blood glucose levels, in hyperglycemic (≥140 mg/dl) and normoglycemic (<140 mg/dl). We analyzed gut and thrombus microbiota in all patients. Moreover, we assessed TMAO, CD40L and von Willebrand Factor (vWF) in coronary thrombi. Cox regressions were used for the association between Prevotellaspp. and TMAO terziles and MACE. MACE endpoint at 1 year included death, re-infarction, unstable angina.

RESULTS RESULTS

In fecal and thrombus samples, we observed a significantly different prevalence of both Prevotellaspp. and Alistipesspp. between patients with hyperglycemia (n = 56) and those with normal glucose levels (n = 90). The abundance of Prevotella increased in hyperglycemic vs normoglycemic patients whereas the contrary was observed for Alistipes. Interestingly, in coronary thrombus, the content of Prevotella was associated with admission blood glucose levels (p < 0.01), thrombus dimensions (p < 0.01), TMAO, CDL40 (p < 0.01) and vWF (p < 0.01) coronary thrombus contents. Multivariate Cox-analysis disclosed a reduced survival in patients with high levels of Prevotella and TMAO in coronary thrombus as compared to patients with low levels of Prevotella and TMAO, after 1-year follow up.

CONCLUSIONS CONCLUSIONS

Hyperglycemia during STEMI may increase coronary thrombus burden via gut and thrombus microbiota dysbiosis characterized by an increase of Prevotella and TMAO content in thrombi.

CLINICAL TRIAL REGISTRATION BACKGROUND

NCT03439592. September 30, 2016. Ethic Committee Vanvitelli University: 268/2016.

Identifiants

DOI: 10.1016/j.diabres.2021.108670 PMID: 33453294

pubmed: 33453294

pii: S0168-8227(21)00023-1

doi: 10.1016/j.diabres.2021.108670

pii:

doi:

Banques de données

ClinicalTrials.gov

['NCT03439592']

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

108670

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declared that there is no conflict of interest.