Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. The predictive value of stress hyperglycemia on thrombus burden in nondiabetic patients with ST-segment elevation myocardial infarction Serhat Sigirci, Su ¨ leyman S. Yildiz, Kudret Keskin, Gokhan Cetinkal, Gokhan Aksan, Ahmet Gu ¨ rdal, S ¸u ¨ kru ¨C ¸ etin, Hakan Kilci and Kadriye O. Kilickesmez M It is established that hyperglycemia directly effects the platelet functions and fibrin structure. In this study, we aimed to investigate the predictive value of hyperglycemia on thrombus burden in nondiabetic patients with ST- segment elevation myocardial infarction (STEMI) who underwent to primer percutaneous coronary intervention (PPCI). We enrolled 619 nondiabetic patients with STEMI who received PPCI. Patients were divided two groups according to thrombus burden. Stress hyperglycemia was determined as blood glucose concentration more than 180 mg/dl and angiographic coronary thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades. Patients with thrombus grades 4 were defined as large thrombus burden (LTB), patients with thrombus burden less than thrombus grades 4 were defined as small thrombus burden. A total of 68 (11.0%) STEMI patients had stress hyperglycemia, while 223 (36.0%) patients had LTB. Sex, the prevalence of hypertension, smoking, and dyslipidemia were not different between the thrombus burden groups (P > 0.05 for all parameters). Compared with the patients with small thrombus burden, the patients with LTB were had significantly higher admission blood glucose concentrations (135 W 39.1 mg/dl vs. 145.9 W 43.1, P U 0.002, respectively). The multivariate logistic regression analysis demonstrated that stress hyperglycemia is an independent predictor of LTB (odds ratio: 3.025, confidence interval 1.200–7.622, P U 0.019). Admission hyperglycemia is associated with the LTB which cause adverse cardiac outcomes. Hyperglycemia may play a role on thrombus development. Blood Coagul Fibrinolysis 30:270–276 Copyright ß 2019 Wolters Kluwer Health, Inc. All rights reserved. Blood Coagulation and Fibrinolysis 2019, 30:270–276 Keywords: acute coronary syndrome, acute hyperglycemia, admission glucose, platelet function, thrombus grade Department of Cardiology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey Correspondence to Serhat Sigirci, Cardiologist, Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Sisli, 34377 Istanbul, Turkey Tel: +00 90 555 636 8034; fax: +00 90 212 224 0772; e-mail: serhatsigirci@gmail.com Received 26 March 2019 Revised 29 May 2019 Accepted 10 June 2019 Introduction ST-segment elevation myocardial infarction (MI) (STEMI) is the most serious type of acute coronary syndrome (ACS) and has high mortality and morbidity. The major cause of STEMI is coronary artery occlusion due to intracoronary thrombus [1]. Thrombus burden in infarct-related artery determines the clinical presentation of patient with ACS, ranging from unstable angina to STEMI [2]. Intracoronary thrombus burden is still a risk factor for no reflow, stent thrombosis, and distal emboli- zation, mid and long-term adverse cardiovascular events [2–6]. Therefore, establishing good predictors of throm- bus burden and associated clinical conditions may con- tribute to the management of STEMI. High blood glucose levels commonly occur in patients with ACS, regardless of whether the patient has diabetes mellitus. High blood glucose levels are caused by the adrenergic stimulation resulting from the stress due to myocardial ischemic event [7]. Hyperglycemia with or without diabetes mellitus is associated with increased in-hospital complications, cardiovascular adverse events and mortal- ity in patients with ACS [8 – 10]. In addition to, hypergly- cemia can directly contribute to the platelet dysfunction and reduced thrombus stability [11]. It is showed that intrinsic platelet reactivity is positively associated with high thrombus burden in infarct-related artery in patient with STEMI [12]. Therefore, we assessed the predictive value of hyperglycemia on thrombus burden in nondia- betic patients with STEMI who underwent to primer percutaneous coronary intervention (PPCI). Material and method Our study consisted of a retrospective cohort included patients with STEMI. Nine hundred and sixty two patients who presented to our hospital with STEMI who underwent PPCI during the period of May 2016 and August 2018 were retrospectively reviewed. The third universal definition of MI was used to diagnose STEMI [13]. The patients who had diabetes mellitus, active infection, autoimmune disease, usage steroid, liver 270 Original article  Professor of Cardiology. 0957-5235 Copyright ß 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI:10.1097/MBC.0000000000000832